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Individual

MR. IAN DANIEL GAULT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MS, LPC-A

Contact information

Practice address
2143 HOFFMEYER RD STE B, FLORENCE, SC 29501-4078
(843) 256-2216
Mailing address
256 TRIPLE J LN, BENNETTSVILLE, SC 29512-8208
(864) 426-7044

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
7582
SC

Other

Enumeration date
02/05/2021
Last updated
02/05/2021
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