Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | DC | |
N | 101YM0800X | Mental Health Counselor |
NPI | 1003485962 |
---|---|
Provider Name | Mrs. Shirley L Gordon |
First Address | Annapolis, MD 21401-2402 |
Second Address | Annapolis, MD 21401-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G635765549569 | STATE ISSUED ID (01) | MD |