Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2477 | NC |
Y | 103TC0700X | Clinical Psychologist | 2477 | NC |
NPI | 1003981051 |
---|---|
Provider Name | Dr. Emily C Gordon |
First Address | Asheville, NC 28804-8742 |
Second Address | Asheville, NC 28804-8742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 15/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0436K | BCBS (01) | NC |
562151539 | TRICARE (01) |