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1922459072 NPI number — LATASHA MONIQUE GORDON LICDC, LPC

NPI Number: 1922459072
Health Care Provider/Practitioner: LATASHA MONIQUE GORDON LICDC, LPC

Information about “1922459072” NPI (LATASHA MONIQUE GORDON LICDC, LPC) exists in 1922459072 in HTML format HTML  |  1922459072 in plain Text format TXT  |  1922459072 in PDF (Portable Document Format) PDF  |  1922459072 in an XML format XML  formats.

NPI Number : 1922459072 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922459072",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GORDON",
    "FirstName": "LATASHA",
    "MiddleName": "MONIQUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LICDC, LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JONES",
    "OtherFirstName": "LATASHA",
    "OtherMiddleName": "MONIQUE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4600 MONTGOMERY RD STE 400",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CINCINNATI",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45212-2600",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5850 RIDGE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PARMA",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44129-3169",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "833-510-4357",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/29/2016",
    "LastUpdateDate": "12/03/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "C.2406556",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "LICDC.162742",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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