Individual
ALEXANDRA MARIE GORDON
Active
Individual
ALEXANDRA MARIE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ON CALL RECOVERY COA
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518996354
—
MA
Enumeration date
09/06/2017
Last updated
07/21/2022
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