Provider Demographics
NPI:1497420228
Name:GORDON, CHARITY RUTH (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHARITY
Middle Name:RUTH
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 1:106 HILLCREST DR.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851
Mailing Address - Country:US
Mailing Address - Phone:662-239-7521
Mailing Address - Fax:662-234-3071
Practice Address - Street 1:100 STARR AVE
Practice Address - Street 2:STE K
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-340-5947
Practice Address - Fax:662-236-3071
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health