Individual
JOSEPH LORN GORDON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
121 DOWNEY AVE, MODESTO, CA 95354-1208
(209) 341-1824
Mailing address
121 DOWNEY AVE, MODESTO, CA 95354-1208
(209) 341-1824
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
SUDRC12754
CA
372600000X
Adult Companion
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2022
Last updated
06/17/2025
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