Provider Demographics
NPI:1598362188
Name:GAINES THERAPY PLLC
Entity Type:Organization
Organization Name:GAINES THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCMHC/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-672-4655
Mailing Address - Street 1:PO BOX 470164
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-0164
Mailing Address - Country:US
Mailing Address - Phone:704-672-4655
Mailing Address - Fax:
Practice Address - Street 1:104 WAXHAW PROFESSIONAL PARK DR STE D
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-5020
Practice Address - Country:US
Practice Address - Phone:704-748-0735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty