Provider Demographics
NPI:1013116631
Name:HORNE, GORDON WILLIAM (LAADC, ICAADC)
Entity type:Individual
Prefix:PROF
First Name:GORDON
Middle Name:WILLIAM
Last Name:HORNE
Suffix:
Gender:M
Credentials:LAADC, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PEACH DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3710
Mailing Address - Country:US
Mailing Address - Phone:831-809-8176
Mailing Address - Fax:831-753-6005
Practice Address - Street 1:11 PEACH DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-809-8176
Practice Address - Fax:831-753-6005
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI0170115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03-063376OtherBOARD CERTIFIED ADDICTIO
CA04/06OtherGRADUATE CALIFORNIA ASSOC
CALICENSE # LCI0170115OtherLICENSED ADVANCED ALCOHOL AND DRUG COUNSELOR (LAADC)
CA04/06OtherGRADUATE CALIFORNIA ASSOC