Most Relevant Information
Provider Data
| NPI Number: | 1003177866 |
| Provider Name: | MAMIE KHAMALAH LUMPKIN- GORDON LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | SW22059 |
Most Important Dates
| Enumeration Date: | 06/07/2012 |
| Last Updated: | 01/04/2024 |
Provider Practice Location
1009 MAITLAND CENTER COMMONS BLVD
#212
MAITLAND
FL
327517270
Practice Location Phone/Fax
| Phone: | 4076363532 |
| Fax: | 3212565292 |
Provider Mailing Location
1009 MAITLAND CENTER COMMONS BLVD
#212
MAITLAND
FL
327517270
Provider Mailing Phone/Fax
| Phone: | 4076363532 |
| Fax: | 3212565292 |