Provider Demographics
NPI:1457647174
Name:GORDY, GLORIA J (GLORIA GORDY)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:GORDY
Suffix:
Gender:F
Credentials:GLORIA GORDY
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:J
Other - Last Name:GORDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GLORIA GORDY
Mailing Address - Street 1:113 ELLERY ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-3194
Mailing Address - Country:US
Mailing Address - Phone:757-375-9026
Mailing Address - Fax:
Practice Address - Street 1:9228 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4162
Practice Address - Country:US
Practice Address - Phone:804-695-8120
Practice Address - Fax:804-695-8122
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182052103TP2701X, 364S00000X, 364SP0809X, 364SP0810X, 101YA0400X
VA0001120029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family