Provider Demographics
NPI:1174907034
Name:GORE, AKIA (LCSWA)
Entity type:Individual
Prefix:
First Name:AKIA
Middle Name:
Last Name:GORE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8374 SIX FORKS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5096
Mailing Address - Country:US
Mailing Address - Phone:919-890-5852
Mailing Address - Fax:
Practice Address - Street 1:8374 SIX FORKS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5096
Practice Address - Country:US
Practice Address - Phone:919-890-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP009614104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker