Provider Demographics
NPI:1649833542
Name:GORDON, JANET (MA, NCC, LCMHC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-0501
Mailing Address - Country:US
Mailing Address - Phone:704-213-7698
Mailing Address - Fax:
Practice Address - Street 1:152 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-0018
Practice Address - Country:US
Practice Address - Phone:704-380-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional