Provider Demographics
NPI:1770191447
Name:GORHAM, THOMAS JAMAAR (QMHP-A)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMAAR
Last Name:GORHAM
Suffix:
Gender:M
Credentials:QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MICHIGAN DR APT F
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-5703
Mailing Address - Country:US
Mailing Address - Phone:252-292-7147
Mailing Address - Fax:
Practice Address - Street 1:6000B JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3266
Practice Address - Country:US
Practice Address - Phone:757-933-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)