Provider Demographics
NPI:1093332173
Name:GORHAM, QUANAZHEA DONYEA
Entity Type:Individual
Prefix:
First Name:QUANAZHEA
Middle Name:DONYEA
Last Name:GORHAM
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 1:5707 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4350
Mailing Address - Country:US
Mailing Address - Phone:813-239-8069
Mailing Address - Fax:813-231-4350
Practice Address - Street 1:5800 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-7128
Practice Address - Country:US
Practice Address - Phone:813-239-8069
Practice Address - Fax:813-231-7324
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician