Provider Demographics
NPI:1093395949
Name:GORHAM, KEBORI LEIGH (LCSWA)
Entity type:Individual
Prefix:
First Name:KEBORI
Middle Name:LEIGH
Last Name:GORHAM
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 620701
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0111
Mailing Address - Country:US
Mailing Address - Phone:704-533-5810
Mailing Address - Fax:980-598-8019
Practice Address - Street 1:5804 MONROE RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6183
Practice Address - Country:US
Practice Address - Phone:704-533-5810
Practice Address - Fax:980-598-8019
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical