Provider Demographics
NPI:1154445682
Name:GOMES, THERESA (LMFTS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GOMES
Suffix:
Gender:F
Credentials:LMFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CARPENTER DR
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9435
Mailing Address - Country:US
Mailing Address - Phone:864-663-2218
Mailing Address - Fax:
Practice Address - Street 1:153 N SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-2309
Practice Address - Country:US
Practice Address - Phone:864-663-2218
Practice Address - Fax:864-564-1999
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC4621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health