Healthcare Provider Details

I. General information

NPI: 1932915675
Provider Name (Legal Business Name): GAVIN NOBLE LAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2024
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BUCKWALTER PKWY STE 3UV
BLUFFTON SC
29910-4132
US

IV. Provider business mailing address

2247 E VICTORY DR
SAVANNAH GA
31404-3919
US

V. Phone/Fax

Practice location:
  • Phone: 843-290-6828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10153
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: