Provider Demographics
NPI:1417581554
Name:GORDON, AALIYAH D'SHAE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:AALIYAH
Middle Name:D'SHAE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-4114
Mailing Address - Country:US
Mailing Address - Phone:413-266-2201
Mailing Address - Fax:413-301-5164
Practice Address - Street 1:605 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4114
Practice Address - Country:US
Practice Address - Phone:413-266-2201
Practice Address - Fax:413-301-5164
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS91450287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health