Healthcare Provider Details

I. General information

NPI: 1306038047
Provider Name (Legal Business Name): MS. DAWN MICHELLE GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CARMEN LN STE A
SANTA MARIA CA
93458-7768
US

IV. Provider business mailing address

124 CARMEN LN STE A
SANTA MARIA CA
93458-7768
US

V. Phone/Fax

Practice location:
  • Phone: 805-348-1850
  • Fax:
Mailing address:
  • Phone: 805-348-1850
  • Fax: 559-248-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: