Provider Demographics
NPI:1235692419
Name:GANTT YOUTH AND FAMILY SERVICES LLC
Entity type:Organization
Organization Name:GANTT YOUTH AND FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TOMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-968-4893
Mailing Address - Street 1:10234 KELSO CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6637
Mailing Address - Country:US
Mailing Address - Phone:704-968-4893
Mailing Address - Fax:704-583-0672
Practice Address - Street 1:9635 SOUTHERN PINE BLVD STE 127
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5563
Practice Address - Country:US
Practice Address - Phone:704-968-4893
Practice Address - Fax:704-583-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20191OtherLEGALZOOM