Healthcare Provider Details

I. General information

NPI: 1720164908
Provider Name (Legal Business Name): LINDA M GANTT PHD ATRBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 SCOTT AVENUE
MORGANTOWN WV
26508
US

IV. Provider business mailing address

314 SCOTT AVENUE
MORGANTOWN WV
26508
US

V. Phone/Fax

Practice location:
  • Phone: 304-291-2912
  • Fax: 304-291-2912
Mailing address:
  • Phone: 304-291-2912
  • Fax: 304-291-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPC001898
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number79001
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: