Provider Demographics
NPI:1891042941
Name:ROMICH, GARY L (LPA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:ROMICH
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 OAK POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021-9304
Mailing Address - Country:US
Mailing Address - Phone:704-477-6931
Mailing Address - Fax:704-482-8640
Practice Address - Street 1:616 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4618
Practice Address - Country:US
Practice Address - Phone:704-482-6776
Practice Address - Fax:704-482-8640
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0899103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist