=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528962644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY JEROME GAITHER JR. MA, LPC-A
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2026
-----------------------------------------------------
Last Update Date | 10/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 FOREST DR STE 400
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-767-8021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 FOREST DR STE 400
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-767-8021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 7800
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------