Active NPI
Chandra S. Gordon, LADAC; LPC
- Addiction (Substance Use Disorder) Counselor
- Grants, NM
National Provider Identifier
1104159060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 0137551
- Practice address
- 1217 Bonita St
Grants, NM 87020-2103 - Phone
- (505) 287-2273
- Fax
- (505) 287-2276
- NPI assigned
- Sep 10, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0137551 | NM | Primary |
| Pastoral Counselor | 101YP1600X | 14967 | FL |
Addresses
Primary practice location
1217 Bonita St
Grants, NM 87020-2103
Mailing address
PO Box 3348
Milan, NM 87021-3348
Phone (505) 240-0823
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0137551 | NM | MD | Addiction (Substance Use Disorder) Counselor |
| 14967 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363824000000",
"number": "1104159060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3348",
"city": "MILAN",
"state": "NM",
"postal_code": "870213348",
"telephone_number": "505-240-0823",
"fax_number": "505-240-0823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 BONITA ST",
"city": "GRANTS",
"state": "NM",
"postal_code": "870202103",
"telephone_number": "505-287-2273",
"fax_number": "505-287-2276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "CHANDRA",
"middle_name": "S.",
"name_prefix": "Ms.",
"credential": "LADAC; LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-10",
"last_updated": "2013-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "0137551",
"primary": true
},
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "FL",
"license": "14967",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.