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General NPI Number Information
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NPI Number | 1750130092
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Entity Type | Individual
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Provider Name | CYNTHIA GORDON LISW-CP
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Gender |
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Dates
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Enumeration Date | 05/17/2024
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 30 POINTE CIR
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City | GREENVILLE
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State | SC
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Zip | 29615-3506
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Country | US
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Telephone | 864-655-5193
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Fax |
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Provider Business Mailing Address
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Address Line | 12110 CANTER TRL
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City | GREENVILLE
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State | SC
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Zip | 29609-0955
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16920
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License Number State | SC
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