Provider Demographics
NPI:1952841850
Name:GORDON, LADY-DREAMA (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:LADY-DREAMA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4889 SINCLAIR RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5433
Mailing Address - Country:US
Mailing Address - Phone:147-811-0006
Mailing Address - Fax:
Practice Address - Street 1:4889 SINCLAIR RD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5433
Practice Address - Country:US
Practice Address - Phone:614-781-1000
Practice Address - Fax:614-781-1038
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16006251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical