Provider Demographics
NPI:1215103544
Name:GORDON, ALDIN LESLIE (LCPC)
Entity type:Individual
Prefix:MR
First Name:ALDIN
Middle Name:LESLIE
Last Name:GORDON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 LOCHNER RD STE 0
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2932
Mailing Address - Country:US
Mailing Address - Phone:443-475-0338
Mailing Address - Fax:410-878-0382
Practice Address - Street 1:1407 LOCHNER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2932
Practice Address - Country:US
Practice Address - Phone:443-475-0338
Practice Address - Fax:410-878-0382
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4829101YM0800X, 101YP2500X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD086022100Medicaid