Provider Demographics
NPI:1740797919
Name:GORDON, VIRGINIA INGE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:INGE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 AIRPORT BLVD STE C200
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3788
Mailing Address - Country:US
Mailing Address - Phone:251-583-6887
Mailing Address - Fax:
Practice Address - Street 1:6576 AIRPORT BLVD STE C200
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3788
Practice Address - Country:US
Practice Address - Phone:251-273-5686
Practice Address - Fax:251-973-8216
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3845101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional