Healthcare Provider Details

I. General information

NPI: 1649055708
Provider Name (Legal Business Name): SAMANTHA GINGLES LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 RATCHFORD DR
DALLAS NC
28034-7599
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-922-5297
  • Fax: 704-922-9841
Mailing address:
  • Phone: 704-874-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA19109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: