Provider Demographics
NPI:1225398910
Name:GAMBLE, CHANTA RENEE
Entity type:Individual
Prefix:MS
First Name:CHANTA
Middle Name:RENEE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHANTA
Other - Middle Name:RENEE
Other - Last Name:LAWTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:812 GRISTINA CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9391
Mailing Address - Country:US
Mailing Address - Phone:843-263-5731
Mailing Address - Fax:
Practice Address - Street 1:12 SCOTTSDALE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9348
Practice Address - Country:US
Practice Address - Phone:843-263-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
SCLPC.8205.PC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst