Individual
ATHENA A GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
904 E. MARTIN LUTHER KING DR, CENTRALIA, IL 62801
(618) 533-1391
(618) 533-0012
Mailing address
904 E. MARTIN LUTHER KING DRIVE, CENTRALIA, IL 62801
(618) 533-1391
(618) 533-0012
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
02/20/2017
Last updated
01/31/2023
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