Provider Demographics
NPI:1932589926
Name:LIPSCOMB, GORDON (LCSW)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NOVEMBER DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2443
Mailing Address - Country:US
Mailing Address - Phone:919-491-4632
Mailing Address - Fax:
Practice Address - Street 1:420 NOVEMBER DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-2443
Practice Address - Country:US
Practice Address - Phone:919-491-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0027381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical