Provider Demographics
NPI:1023475159
Name:GORDON, CHRISTINA ANN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
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 1:3018 OLD MINDEN RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2476
Mailing Address - Country:US
Mailing Address - Phone:318-746-1935
Mailing Address - Fax:
Practice Address - Street 1:2525 YOUREE DR STE 110
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3600
Practice Address - Country:US
Practice Address - Phone:318-678-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker