Individual
AUDREY NICOLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC. LCDC
Contact information
Practice address
7979 BROADWAY STE 100, SAN ANTONIO, TX 78209-2657
(571) 499-1064
Mailing address
PO BOX 748465, ATLANTA, GA 30374-8465
(855) 284-7483
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15966
TX
101YM0800X
Mental Health Counselor
87094
TX
101YP2500X
Professional Counselor
Primary
87094
TX
Other
Enumeration date
11/23/2021
Last updated
01/23/2024
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