# GORDON WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376928101
- **Authorized official:** MRS. TONYA DORLINE JOHNSON LCSW (OWNER)
- **Authorized official phone:** (757) 534-7840

## Contact information

- **Practice address:** 610 THIMBLE SHOALS BLVD \# 403, NEWPORT NEWS, VA 23606-2573
- **Practice address phone:** (757) 534-7840
- **Practice address fax:** (757) 506-0432
- **Mailing address:** 610 THIMBLE SHOALS BLVD, 401-A, NEWPORT NEWS, VA 23606-2573
- **Mailing address phone:** (757) 534-7840
- **Mailing address fax:** (757) 534-7844

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 090400826 | VA | Yes |

## Other

- **Enumeration date:** 07/22/2015
- **Last updated:** 07/09/2024