Provider Demographics
NPI:1376568592
Name:GORDON, SARAH M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S COLONIAL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1400
Mailing Address - Country:US
Mailing Address - Phone:704-332-3034
Mailing Address - Fax:704-335-8717
Practice Address - Street 1:118 S COLONIAL AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1400
Practice Address - Country:US
Practice Address - Phone:704-332-3034
Practice Address - Fax:704-335-8717
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001967101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002505Medicaid