Provider Demographics
NPI:1922577758
Name:GORDON, PATRICIA ANN (LACS, CS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:LACS, CS
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LACS, CS
Mailing Address - Street 1:317 SPRINGLAKES ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 AIRPORT RD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2617
Practice Address - Country:US
Practice Address - Phone:864-234-7952
Practice Address - Fax:864-234-7985
Is Sole Proprietor?:No
Enumeration Date:2018-11-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC559101YA0400X
SC809101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)