Provider Demographics
NPI:1558705434
Name:GORDON, MARSHA DONNITA (MA)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:DONNITA
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 UPPER RIDGE DR APT 12
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4482
Mailing Address - Country:US
Mailing Address - Phone:248-368-0276
Mailing Address - Fax:
Practice Address - Street 1:48585 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-4402
Practice Address - Country:US
Practice Address - Phone:586-884-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013515101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor