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General NPI Number Information
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NPI Number | 1447496740
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Entity Type | Individual
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Provider Name | CHARLAMONTE L GORDON RSW, M.ED, LPC
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Gender | Female
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1307 PETERMAN DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3437
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Country | US
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Telephone | 318-443-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 POWELL LN
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City | ALEXANDRIA
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State | LA
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Zip | 71303-4928
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Country | US
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Telephone | 318-542-1535
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Fax |
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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 | 4528
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License Number State | LA
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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 |
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License Number State |
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