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General NPI Number Information
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NPI Number | 1558807644
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Entity Type | Individual
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Provider Name | LINDA GORHAM PHD, MDIV
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Gender | Female
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 05/08/2021
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Provider Practice Location Address
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Address Line | 20870 OLD YORK RD
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City | PARKTON
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State | MD
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Zip | 21120-9137
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Country | US
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Telephone | 410-357-9274
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Fax | 410-357-9276
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Provider Business Mailing Address
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Address Line | 20870 OLD YORK RD
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City | PARKTON
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State | MD
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Zip | 21120-9137
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Country | US
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Telephone | 410-340-2843
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Fax | 410-357-9274
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 06482
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License Number State | MD
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