Healthcare Provider Details

I. General information

NPI: 1366806978
Provider Name (Legal Business Name): WHITNEY GORDON M.A. LPCC LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 G AVE
CORONADO CA
92118-2511
US

IV. Provider business mailing address

1510 PARK VIEW PL
CORONADO CA
92118-2622
US

V. Phone/Fax

Practice location:
  • Phone: 774-392-1065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: