Healthcare Provider Details

I. General information

NPI: 1790748366
Provider Name (Legal Business Name): FRANK ELWIN GANTZ III PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER (11M-2) 1601 BRENNER AV
SALISBURY NC
28144
US

IV. Provider business mailing address

445 DELBURG ST
DAVIDSON NC
28036-6945
US

V. Phone/Fax

Practice location:
  • Phone: 704-638-9000
  • Fax: 704-638-3488
Mailing address:
  • Phone: 704-892-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1775
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1775
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1775
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1775
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1775
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1775
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1775
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1775
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: