Provider Demographics
NPI:1942356340
Name:GORDON, CHRISTY ELAINE (MS LCPC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ELAINE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5588
Mailing Address - Country:US
Mailing Address - Phone:301-990-4121
Mailing Address - Fax:443-262-9603
Practice Address - Street 1:244 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5588
Practice Address - Country:US
Practice Address - Phone:301-519-0155
Practice Address - Fax:443-262-9603
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional