Provider Demographics
NPI:1619379591
Name:GORDON, CARTER TAYLOR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARTER
Middle Name:TAYLOR
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARTER
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5318 PATTERSON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2044
Mailing Address - Country:US
Mailing Address - Phone:804-971-7261
Mailing Address - Fax:804-533-5021
Practice Address - Street 1:5318 PATTERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2044
Practice Address - Country:US
Practice Address - Phone:804-971-7261
Practice Address - Fax:804-533-5021
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical