Provider Demographics
NPI:1942171327
Name:GORDON, ROSE COOPER
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:COOPER
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1331
Mailing Address - Country:US
Mailing Address - Phone:804-780-6267
Mailing Address - Fax:804-780-6051
Practice Address - Street 1:211 WESTMORELAND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1331
Practice Address - Country:US
Practice Address - Phone:804-780-6267
Practice Address - Fax:804-780-6267
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0600859101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool