Provider Demographics
NPI:1376721522
Name:GORDON-MAZUR, FAITH DONNA (LPC)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:DONNA
Last Name:GORDON-MAZUR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:DONNA
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:525 S 4TH ST
Mailing Address - Street 2:SUITE 471
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1570
Mailing Address - Country:US
Mailing Address - Phone:267-861-3685
Mailing Address - Fax:215-965-1513
Practice Address - Street 1:525 S 4TH ST
Practice Address - Street 2:SUITE 471
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1570
Practice Address - Country:US
Practice Address - Phone:267-861-3685
Practice Address - Fax:215-965-1513
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional