Provider Demographics
NPI:1922357391
Name:GORDON, RUBY KATHERINE (MA,EDS,LPC)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:KATHERINE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA,EDS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2186
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-6186
Mailing Address - Country:US
Mailing Address - Phone:704-214-7237
Mailing Address - Fax:855-306-2963
Practice Address - Street 1:307 E KING ST STE A
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3492
Practice Address - Country:US
Practice Address - Phone:704-214-7237
Practice Address - Fax:855-306-2963
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health