Provider Demographics
NPI:1871504241
Name:GORDY, JENNIFER S (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:GORDY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WATERCOURSE CIR
Mailing Address - Street 2:APT 102
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3193
Mailing Address - Country:US
Mailing Address - Phone:336-525-1590
Mailing Address - Fax:
Practice Address - Street 1:200 N MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:336-525-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical