Provider Demographics
NPI:1952431629
Name:GORDON, GARY LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:GORDON
Suffix:
Gender:M
Credentials:LCSW
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Other - First Name:
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Mailing Address - Street 1:6551 LOISDALE COURT
Mailing Address - Street 2:SUITE 155
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1808
Mailing Address - Country:US
Mailing Address - Phone:703-921-0692
Mailing Address - Fax:703-921-0637
Practice Address - Street 1:6800 BACKLICK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3070
Practice Address - Country:US
Practice Address - Phone:703-921-0692
Practice Address - Fax:703-921-0692
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA09040035521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical