Provider Demographics
NPI:1104076744
Name:GORDON, HEIDI SHAMENE (MSW)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:SHAMENE
Last Name:GORDON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 ARBOURGATE MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9073
Mailing Address - Country:US
Mailing Address - Phone:980-808-9674
Mailing Address - Fax:
Practice Address - Street 1:9216 ARBOURGATE MEADOWS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9073
Practice Address - Country:US
Practice Address - Phone:980-808-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0159181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical