Provider Demographics
NPI:1336398114
Name:EMILY C GORDON PHD PA
Entity Type:Organization
Organization Name:EMILY C GORDON PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CLINICAL PSYCHOL
Authorized Official - Phone:828-645-1539
Mailing Address - Street 1:540 AIKEN RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-8742
Mailing Address - Country:US
Mailing Address - Phone:828-645-1539
Mailing Address - Fax:828-299-0067
Practice Address - Street 1:540 AIKEN RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-8742
Practice Address - Country:US
Practice Address - Phone:828-645-1539
Practice Address - Fax:828-299-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0436KOtherBCBS
=========OtherTRICARE