Provider Demographics
NPI:1659926087
Name:GORDON, KRISTINA (LCMHC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 MIRANDA DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-5683
Mailing Address - Country:US
Mailing Address - Phone:910-229-1445
Mailing Address - Fax:
Practice Address - Street 1:5135 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1525
Practice Address - Country:US
Practice Address - Phone:910-978-2491
Practice Address - Fax:910-500-0417
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health