Provider Demographics
NPI:1679642193
Name:GANTZ, JOAN E (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:E
Last Name:GANTZ
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 PATHWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-4100
Mailing Address - Country:US
Mailing Address - Phone:919-345-7580
Mailing Address - Fax:
Practice Address - Street 1:1530 PATHWAY DRIVE
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-4100
Practice Address - Country:US
Practice Address - Phone:919-345-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC908106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC341441OtherMHN