Provider Demographics
NPI:1861016651
Name:GORDON, ANTHONY (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S HAYS ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3615
Mailing Address - Country:US
Mailing Address - Phone:410-877-1027
Mailing Address - Fax:
Practice Address - Street 1:120 S HAYS ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3615
Practice Address - Country:US
Practice Address - Phone:410-877-1027
Practice Address - Fax:410-420-3435
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC10489OtherSTATE LICENSE