Healthcare Provider Details

I. General information

NPI: 1205184702
Provider Name (Legal Business Name): NAILAH GUMBS-FAHIE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 EXECUTIVE CTR DR STE 100
ORLANDO FL
32803-3521
US

IV. Provider business mailing address

225 BROMWICH DR
KISSIMMEE FL
34758-2703
US

V. Phone/Fax

Practice location:
  • Phone: 321-282-3840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: