Individual
WILLIAM THOMAS GORHAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
878 W STAR ST, GREENVILLE, NC 27834-0844
(252) 417-6829
Mailing address
878 W STAR ST, GREENVILLE, NC 27834-0844
(252) 417-6829
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NC
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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