Individual
NICOLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10000 N 31ST AVE STE D407, PHOENIX, AZ 85051-1352
(602) 718-1266
Mailing address
6537 N 55TH AVE # 473, GLENDALE, AZ 85301-3959
(602) 718-1266
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LCSW-17933
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW-17933
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000710
—
AZ
05
—
087415
—
AZ
Enumeration date
09/24/2019
Last updated
07/20/2023
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