Provider Demographics
NPI:1548914831
Name:LOUWAGIE GORDON, ALISSA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:LOUWAGIE GORDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SW 107TH AVE STE 42
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2492
Mailing Address - Country:US
Mailing Address - Phone:507-829-5589
Mailing Address - Fax:
Practice Address - Street 1:2500 SW 107TH AVE STE 42
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2492
Practice Address - Country:US
Practice Address - Phone:786-615-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health