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ALICIA GORDON LCSW

Developmental Disabilities >> Clinic/Center >> Ambulatory Health Care Facilities

Registrant NPI Number: 1285149955

Individual Registrant:
 ALICIA  GORDON LCSW
Gender: F
Sole Proprietor

Location and contact information for practice:
132 CAROL CIR  FITZGERALD, GA 31750-8128 US
Tel: 561-252-7261  Fax: --

Contact information for business:
5464 CLUB CIR  HAVERHILL, FL 33415-1262 US
Tel: 561-252-7261  Fax: --

Registration Information:
NPI: 1285149955
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QD1600XAmbulatory Health Care Facilities
Clinic/Center
Developmental Disabilities
FL

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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