Individual
AMANDA B GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, CD(DONA)
Contact information
Practice address
1350 W FULLERTON AVE, #305, CHICAGO, IL 60614-2198
(773) 304-6483
Mailing address
1350 W. FULLERTON, #305, CHICAGO, IL 60614
(773) 304-6483
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180.007445
IL
Other
Enumeration date
02/12/2013
Last updated
02/12/2013
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