Provider Demographics
NPI:1396183091
Name:GORDON, MIA EMILY (LPC)
Entity Type:Individual
Prefix:MS
First Name:MIA
Middle Name:EMILY
Last Name:GORDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W CAPITOL AVE STE 1213
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3405
Mailing Address - Country:US
Mailing Address - Phone:501-679-1469
Mailing Address - Fax:201-581-1615
Practice Address - Street 1:204 EXECUTIVE CT STE 301
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4532
Practice Address - Country:US
Practice Address - Phone:501-679-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1508084101YP2500X
ARA1305056101YM0800X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center