Stacey Gordon
Individual provider Active NPI Mental Health Counselor · Marriottsville, MD
NPI 1639936065 · NPPES record last updated Mar 4, 2024
Key facts
- NPI
- 1639936065
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- LGP14889 (MD)
- Practice address
- 11155 Stratfield CT
Marriottsville, MD 21104-1650 - Phone
- (443) 718-9197
- NPI assigned
- Mar 4, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LGP14889 | MD | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LGP14889 | MD | Yes |
Addresses
Primary practice location
11155 Stratfield CT
Marriottsville, MD 21104-1650
Mailing address
11155 Stratfield CT
Marriottsville, MD 21104-1650
Other providers in Marriottsville, MD
- Joelle L Frizzera
- Fundamental Solutions Psychotherapy. LLC
- Rani Mathew George
- Hazel Denise Glasper
- Kelly Nicole Goldberg
- Joanne McLane Hardesty
- Margaret Ruth Hargrove
- HCPT LLC
- Help Me Speak, LLC
- Shawn Michael Herlong
All providers in Marriottsville, MD · Mental Health Counselor in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.