Provider Demographics
NPI:1912529207
Name:GORDON, DEIRDRA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DEIRDRA
Other - Middle Name:SHANEL
Other - Last Name:PLEDGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:5410 PHOENIX AVE UNIT 134
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6054
Mailing Address - Country:US
Mailing Address - Phone:479-388-1272
Mailing Address - Fax:
Practice Address - Street 1:5410 PHOENIX AVENUE
Practice Address - Street 2:UNIT # 134
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6054
Practice Address - Country:US
Practice Address - Phone:479-388-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1902016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health