Provider Demographics
NPI:1679980395
Name:GORDON, FRANCINE
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 STEWART PKWY UNIT 6271
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-1114
Mailing Address - Country:US
Mailing Address - Phone:770-415-3601
Mailing Address - Fax:678-534-8986
Practice Address - Street 1:12461 VETERANS MEMORIAL HWY, SUITE # 631
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2025
Practice Address - Country:US
Practice Address - Phone:770-415-3601
Practice Address - Fax:678-534-8986
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical