Provider Demographics
NPI:1629372081
Name:GORDON, SHANIQUA RASHEDA (MRC)
Entity Type:Individual
Prefix:MS
First Name:SHANIQUA
Middle Name:RASHEDA
Last Name:GORDON
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 N POINT CT APT D
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4169
Mailing Address - Country:US
Mailing Address - Phone:850-245-3440
Mailing Address - Fax:
Practice Address - Street 1:2674 N POINT CT APT D
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4169
Practice Address - Country:US
Practice Address - Phone:850-245-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor