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General NPI Number Information
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NPI Number | 1730495474
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Entity Type | Individual
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Provider Name | MS. QUJANE K GORDON
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Gender | Female
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 1 PERKINS SQ
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City | AKRON
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State | OH
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Zip | 44308-1063
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Country | US
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Telephone | 330-543-5015
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Fax | 330-543-3856
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Provider Business Mailing Address
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Address Line | 87 N CANTON RD
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City | AKRON
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State | OH
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Zip | 44305-3838
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Country | US
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Telephone | 330-794-4254
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Fax | 330-794-4262
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.1000329-SUPV
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License Number State | OH
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