Healthcare Provider Details

I. General information

NPI: 1437297462
Provider Name (Legal Business Name): TINA LOUISE GAUDIANO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 GROCE RD
LYMAN SC
29365
US

IV. Provider business mailing address

84 GROCE RD
LYMAN SC
29365
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-7760
  • Fax: 864-439-7034
Mailing address:
  • Phone: 864-439-7760
  • Fax: 864-439-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 4268
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: