Provider Demographics
NPI:1275709016
Name:GORHAM, ENOLA GAYE (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:ENOLA
Middle Name:GAYE
Last Name:GORHAM
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 S NIAGARA WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2513
Mailing Address - Country:US
Mailing Address - Phone:720-220-0451
Mailing Address - Fax:
Practice Address - Street 1:2186 S HOLLY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5609
Practice Address - Country:US
Practice Address - Phone:720-220-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96301451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical