Provider Demographics
NPI:1619176211
Name:GORDON, SHEREESE TAMICA
Entity Type:Individual
Prefix:MRS
First Name:SHEREESE
Middle Name:TAMICA
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:SHEREESE
Other - Middle Name:TAMICA
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10506 THRIFT RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3734
Mailing Address - Country:US
Mailing Address - Phone:301-292-2778
Mailing Address - Fax:301-292-0275
Practice Address - Street 1:10506 THRIFT RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3734
Practice Address - Country:US
Practice Address - Phone:301-292-2778
Practice Address - Fax:301-292-0275
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional