Provider Demographics
NPI:1770817462
Name:POLSTON, GAYLE R (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:R
Last Name:POLSTON
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Gender:F
Credentials:MA, LPC, NCC
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Mailing Address - Street 1:704 S FRANKLIN DR
Mailing Address - Street 2:LIFE CHANGING SOLUTIONS
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4504
Mailing Address - Country:US
Mailing Address - Phone:843-669-4233
Mailing Address - Fax:843-472-5021
Practice Address - Street 1:1807 CHEROKEE RD STE 202
Practice Address - Street 2:LIFE CHANGING SOLUTIONS, LLC
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3101
Practice Address - Country:US
Practice Address - Phone:843-669-4233
Practice Address - Fax:843-472-5021
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2013-07-11
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Provider Licenses
StateLicense IDTaxonomies
SC5064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional