Provider Demographics
NPI:1447496740
Name:GORDON, CHARLAMONTE L (RSW, MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHARLAMONTE
Middle Name:L
Last Name:GORDON
Suffix:
Gender:
Credentials:RSW, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 POWELL LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4928
Mailing Address - Country:US
Mailing Address - Phone:318-542-1535
Mailing Address - Fax:
Practice Address - Street 1:1307 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3437
Practice Address - Country:US
Practice Address - Phone:318-443-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4528101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional