Provider Demographics
NPI:1598220386
Name:GORDON, DANIELLE S (MA, NCC, LLPC, SCL)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:S
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, NCC, LLPC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29997 VALLEY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2067
Mailing Address - Country:US
Mailing Address - Phone:248-878-3759
Mailing Address - Fax:
Practice Address - Street 1:29997 VALLEY SIDE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2067
Practice Address - Country:US
Practice Address - Phone:248-878-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC0000000755886101YS0200X
MI6401012328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool