Latasha Monique Gordon, LICDC, LPC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LICDC.162742 Issued in OH

Practice address

5850 Ridge Rd
Parma, OH 44129-3169

Phone

(833) 510-4357

NPI assigned

Jun 29, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Latasha Monique Jones Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jeanettes Sanctuary LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Elyria, OH
  • NPI 1710788419
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1922459072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MONTGOMERY RD STE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5850 RIDGE RD",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441293169",
            "telephone_number": "833-510-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "LATASHA",
        "middle_name": "MONIQUE",
        "credential": "LICDC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C.2406556",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.162742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LATASHA",
            "last_name": "JONES",
            "middle_name": "MONIQUE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Elyra Gonzalez
• Lucas Bertaud Gonzalez, QMHS
• Maria Gonzalez
• Roger Goomber, M.D.
• Eric Lawrence Gordon, DDS
• Ruth Gordon, MOT, OTR/L
• Supriya Goyal, M.D.
• Anycia M. R. Grady, MSSA, LISW-S
• Kirstin Grady, MPAS, PA-C
• Heather Renee Graham, NP

• Addiction (Substance Use Disorder) Counselor in Parma, OH
• Providers in Parma, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.