Organization
GANTT YOUTH AND FAMILY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMEKA GANTT LPC (THERAPIST)
(704) 968-4893
Entity
Organization
Contact information
Practice address
9635 SOUTHERN PINE BLVD STE 127, CHARLOTTE, NC 28273-5563
(704) 968-4893
(704) 583-0672
Mailing address
10234 KELSO CT, CHARLOTTE, NC 28278-6637
(704) 968-4893
(704) 583-0672
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20191
LEGALZOOM
NC
Enumeration date
04/13/2019
Last updated
04/13/2019
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