Provider Demographics
NPI:1013358621
Name:GANT, LORI M (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:M
Last Name:GANT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W. 5TH NORTH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6512
Mailing Address - Country:US
Mailing Address - Phone:843-695-8865
Mailing Address - Fax:843-695-8517
Practice Address - Street 1:200 W. 5TH NORTH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6512
Practice Address - Country:US
Practice Address - Phone:843-695-8865
Practice Address - Fax:843-695-8517
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid