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Individual

MS. LISA G GORDON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
6800 BACKLICK RD, SUITE #202, SPRINGFIELD, VA 22150-3070
(703) 921-0692
(703) 921-0637
Mailing address
6800 BACKLICK RD, SUITE #202, SPRINGFIELD, VA 22150-3070
(703) 921-0692
(703) 921-0637

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0904003348
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
104300
UNITED HEALTH CARE
01
126464
HEALTHNET FEDERAL SERVICE
01
1550330001
GREAT WEST HEALTHCARE
01
182922
ANTHEM HEALTHKEEPERS
01
2037724
CIGNA
01
268559
MDIPA
01
282455
AETNA
01
323386
MHN
01
4294
BCBS
01
IP282455
MAGELLAN BEHAVIORAL HEALT
Enumeration date
01/08/2007
Last updated
06/01/2009
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