Provider Demographics
NPI:1902634603
Name:GORDON, DAVID A (LAPC, LMLP-T)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GORDON
Suffix:
Gender:M
Credentials:LAPC, LMLP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 SAINT CLAIR CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9285
Mailing Address - Country:US
Mailing Address - Phone:717-201-5435
Mailing Address - Fax:
Practice Address - Street 1:100 WINDING CREEK BLVD # 3
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1883
Practice Address - Country:US
Practice Address - Phone:717-590-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03333-T101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional