Individual
LETEISHA MECHI'ELL GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 PRESSON BLVD, RICHMOND, VA 23224-8020
(804) 299-1932
Mailing address
PO BOX 7629, HENRICO, VA 23231-0129
(804) 299-1932
Taxonomy
Speciality
Code
Description
License number
State
171WV0202X
Vehicle Modifications Contractor
Primary
T63629900
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T63629900
DMV LICENSE
VA
Enumeration date
01/11/2021
Last updated
01/11/2021
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