| Doctor Name: | MRS. QUANDRA ZAKETA GUMBO |
| NPI Number: | 1316261662 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P-LCSW |
| License Number: | P004495 |
| Business Practice Address: | 300 Veazey Dr Butner, NC - 275091668 |
| Business Phone Number: | 9197645519 |
| Business Fax Number: | 9197642274 |
| Mailing Address: | 300 Veazey Dr, BUTNER |
| State: | NC |
| Postal Code: | 275091668 |
| Phone Number: | 9197645519 |
| Fax Number: | 9197642274 |
| NPI Enumeration Date: | 03/16/2010 |
| NPI Last Update Date: | 03/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | P004495 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |