Provider Demographics
NPI:1598235871
Name:GORHAM, TALISHA K (LPC)
Entity Type:Individual
Prefix:
First Name:TALISHA
Middle Name:K
Last Name:GORHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 ASHFORD PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7465
Mailing Address - Country:US
Mailing Address - Phone:804-261-7593
Mailing Address - Fax:
Practice Address - Street 1:10571 TELEGRAPH RD STE 120
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4652
Practice Address - Country:US
Practice Address - Phone:757-575-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional