MEDICARE: MRS. TASHA GANTHIER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C007637	NC

General Provider Information

NPI Number	:	1184998130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TASHA GANTHIER LCSW

Provider Business Mailing Address
First Line	:	1931 J N PEASE PL
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4544
Country	:	US
Telephone Number	:	917-334-7588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 J N PEASE PL
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4544
Country	:	US
Telephone Number	:	917-334-7588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	01/05/2015

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