Individual
MATTHEW LUCAS GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
711 W 40TH ST STE 206, BALTIMORE, MD 21211-2108
(410) 842-6055
Mailing address
5104 YORK ROAD, STUDENT LIFE- SETON 08B, BALTIMORE, MD 21212
(470) 833-8900
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A01046
MD
390200000X
Student in an Organized Health Care Education/Training Program
A01046
MD
Other
Enumeration date
10/11/2024
Last updated
03/04/2025
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