Individual
DIANA L GANTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5228 NE HOYT ST BLDG B, PORTLAND, OR 97213-3055
(503) 215-6474
(503) 215-6477
Mailing address
5228 NE HOYT ST BLDG B, PORTLAND, OR 97213-3055
(503) 215-6474
(503) 215-6477
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C1359
OR
101YP2500X
Professional Counselor
Primary
C1359
OR
Other
Enumeration date
01/06/2016
Last updated
09/30/2024
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