Individual
JAMIE LEE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-S
Contact information
Practice address
920 MITCHELL ST, CONWAY, AR 72034-5148
(501) 620-0162
Mailing address
920 MITCHELL ST, CONWAY, AR 72034-5148
(501) 620-0162
(479) 890-5364
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P0509059
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639558398
NPPES
AR
01
—
1639558398
NPPES
—
Enumeration date
08/15/2006
Last updated
04/28/2024
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