Healthcare Provider Details

I. General information

NPI: 1083920474
Provider Name (Legal Business Name): TIMOTHY DAVID GORDON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 563
HILLSBOROUGH NC
27278-0563
US

IV. Provider business mailing address

1306 PROFESSOR PL
DURHAM NC
27713-5909
US

V. Phone/Fax

Practice location:
  • Phone: 919-699-1183
  • Fax: 919-944-4325
Mailing address:
  • Phone: 919-646-2811
  • Fax: 919-944-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4784
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: