Individual
LAKEISHA SHONTA GANTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2750 LEXINGTON RD, ATHENS, GA 30605-2406
(706) 389-8207
Mailing address
225 SWANSON DR, ATHENS, GA 30606-3219
(706) 389-8207
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LPC006380
GA
103TC0700X
Clinical Psychologist
Primary
PSY003777
GA
Other
Enumeration date
03/27/2012
Last updated
07/10/2024
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