Provider Demographics
NPI:1184998130
Name:GANTHIER, TASHA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:
Last Name:GANTHIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 J N PEASE PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4544
Mailing Address - Country:US
Mailing Address - Phone:917-334-7588
Mailing Address - Fax:
Practice Address - Street 1:1931 J N PEASE PL
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4544
Practice Address - Country:US
Practice Address - Phone:917-334-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical