Healthcare Provider Details

I. General information

NPI: 1922459072
Provider Name (Legal Business Name): LATASHA MONIQUE GORDON LICDC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATASHA MONIQUE JONES

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 RIDGE RD
PARMA OH
44129-3169
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 400
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162742
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2406556
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: