Provider Demographics
NPI:1932189891
Name:GORDON-LAND, CARRIE W (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:W
Last Name:GORDON-LAND
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAIN ST
Mailing Address - Street 2:LL1
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3216
Mailing Address - Country:US
Mailing Address - Phone:203-227-2724
Mailing Address - Fax:203-256-9999
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:LL1
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3216
Practice Address - Country:US
Practice Address - Phone:203-227-2724
Practice Address - Fax:203-256-9999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional