Provider Demographics
NPI:1477391654
Name:GORDON, PIA
Entity type:Individual
Prefix:
First Name:PIA
Middle Name:
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 1:301 E 3RD ST # 167
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1509
Mailing Address - Country:US
Mailing Address - Phone:434-694-8108
Mailing Address - Fax:
Practice Address - Street 1:145 DRY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-5446
Practice Address - Country:US
Practice Address - Phone:434-694-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No175T00000XOther Service ProvidersPeer Specialist
No374U00000XNursing Service Related ProvidersHome Health Aide