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General NPI Number Information
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NPI Number | 1396183091
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Entity Type | Individual
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Provider Name | MIA EMILY GORDON LPC
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Gender | Female
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 204 EXECUTIVE CT STE 301
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4532
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Country | US
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Telephone | 501-679-1469
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Fax |
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Provider Business Mailing Address
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Address Line | 425 W CAPITOL AVE STE 1213
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City | LITTLE ROCK
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State | AR
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Zip | 72201-3405
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Country | US
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Telephone | 501-679-1469
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Fax | 201-581-1615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1508084
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1305056
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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