Provider Demographics
NPI:1134717838
Name:GAMBLA, ANNEMARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANNEMARIE
Middle Name:
Last Name:GAMBLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNEMARIE
Other - Middle Name:
Other - Last Name:LAMENDOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:82 DOLPHIN POINT DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1715
Mailing Address - Country:US
Mailing Address - Phone:843-263-0521
Mailing Address - Fax:
Practice Address - Street 1:82 DOLPHIN POINT DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1715
Practice Address - Country:US
Practice Address - Phone:843-263-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4181OtherLLR