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ALICIA GORDON LCSW
Developmental Disabilities >> Clinic/Center >> Ambulatory Health Care FacilitiesRegistrant NPI Number: 1285149955
Individual Registrant: ALICIA GORDON LCSW
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
132 CAROL CIR FITZGERALD, GA 31750-8128 US
Tel: 561-252-7261 Fax: --
Tel: 561-252-7261 Fax: --
Contact information for business:
5464 CLUB CIR HAVERHILL, FL 33415-1262 US
Tel: 561-252-7261 Fax: --
Tel: 561-252-7261 Fax: --
Registration Information:
NPI: 1285149955
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 261QD1600X | Ambulatory Health Care Facilities Clinic/Center Developmental Disabilities | FL |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
