Provider Demographics
NPI:1194325142
Name:GORDON LEGACY LLC
Entity type:Organization
Organization Name:GORDON LEGACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LADY-DREAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOIR
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC
Authorized Official - Phone:614-600-6309
Mailing Address - Street 1:2996 SUMMIT SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3498
Mailing Address - Country:US
Mailing Address - Phone:614-594-9027
Mailing Address - Fax:
Practice Address - Street 1:2996 SUMMIT SPRINGS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3498
Practice Address - Country:US
Practice Address - Phone:614-594-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health