Provider Demographics
NPI:1346799970
Name:GORDON, AISHA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 212G
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217
Mailing Address - Country:US
Mailing Address - Phone:904-343-5008
Mailing Address - Fax:904-765-0664
Practice Address - Street 1:3733 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 212G
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217
Practice Address - Country:US
Practice Address - Phone:904-343-5008
Practice Address - Fax:904-765-0664
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLLCSW214191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical