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General NPI Number Information
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NPI Number | 1871144535
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Entity Type | Individual
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Provider Name | NICOLE GORDON LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 10000 N 31ST AVE STE D407
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City | PHOENIX
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State | AZ
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Zip | 85051-1352
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Country | US
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Telephone | 602-718-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 6537 N 55TH AVE # 473
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City | GLENDALE
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State | AZ
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Zip | 85301-3959
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Country | US
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Telephone | 602-718-1266
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LCSW-17933
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-17933
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License Number State | AZ
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