Provider Demographics
NPI:1528489333
Name:GORHAM, CANDACE RENEE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:RENEE
Last Name:GORHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:CANDACE
Other - Middle Name:RENEE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4104 BRENMAR LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8172
Mailing Address - Country:US
Mailing Address - Phone:919-885-5123
Mailing Address - Fax:
Practice Address - Street 1:607 DUPREE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4527
Practice Address - Country:US
Practice Address - Phone:919-491-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health