Provider Demographics
NPI:1891279220
Name:GORDON, WENDI
Entity Type:Individual
Prefix:MRS
First Name:WENDI
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 1:7310 DODDINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9420
Mailing Address - Country:US
Mailing Address - Phone:301-728-4607
Mailing Address - Fax:
Practice Address - Street 1:7310 DODDINGTON CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9420
Practice Address - Country:US
Practice Address - Phone:301-728-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD82-0843316OtherA DIFFERENT PERSPECTIVE COUNSELING SERVICES