Provider Demographics
NPI:1083182091
Name:GOBOURNE BEHAVIORAL HEALTH & COUNSELING, PLLC
Entity Type:Organization
Organization Name:GOBOURNE BEHAVIORAL HEALTH & COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ZAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW, LICSW
Authorized Official - Phone:301-613-5838
Mailing Address - Street 1:7059 BLAIR RD NW STE 202-2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1959
Mailing Address - Country:US
Mailing Address - Phone:301-613-5838
Mailing Address - Fax:
Practice Address - Street 1:7059 BLAIR RD NW STE 202-2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1959
Practice Address - Country:US
Practice Address - Phone:301-613-5838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty