Healthcare Provider Details

I. General information

NPI: 1093652067
Provider Name (Legal Business Name): JEFF GORDON MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GARDEN CITY DR STE 201
HYATTSVILLE MD
20785-6102
US

IV. Provider business mailing address

4301 GARDEN CITY DR STE 201
HYATTSVILLE MD
20785-6102
US

V. Phone/Fax

Practice location:
  • Phone: 443-839-0012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: