Healthcare Provider Details

I. General information

NPI: 1518810647
Provider Name (Legal Business Name): DONTRELL GOURDINE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 ABIDING WAY
MONCKS CORNER SC
29461
US

IV. Provider business mailing address

302 ABIDING WAY
MONCKS CORNER SC
29461
US

V. Phone/Fax

Practice location:
  • Phone: 843-377-3963
  • Fax:
Mailing address:
  • Phone: 843-377-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8344
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: