Individual provider Active NPI

Timothy Gant, LPC, LCAS, CSI

  • Professional Counselor
  • Fayetteville, NC
National Provider Identifier
1801126909
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
8839 Issued in NC
Practice address
1521 Owen Park LN
Fayetteville, NC 28304-3454
Phone
(910) 321-6006
Fax
(877) 795-6252
NPI assigned
Jan 12, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 8839 NC
Addiction (Substance Use Disorder) Counselor 101YA0400X 1876 NC
Mental Health Counselor 101YM0800X 8839 NC
Professional Counselor 101YP2500X 8839 NC Primary

Addresses

Primary practice location

1521 Owen Park LN
Fayetteville, NC 28304-3454

Mailing address

1521 Owen Park LN
Fayetteville, NC 28304-3454
Phone (910) 321-6006

Other identifiers 1

IdentifierTypeStateIssuer
6601052MedicaidNC

Other names 1

  • Tim Gant Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8839NCMDProfessional Counselor
1876NCMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
A Brighter Future Medical CurrentSince Aug 3, 2025 Accepting new patients
Ernesto J F Graham MD PA CurrentSince Aug 3, 2025 Accepting new patients

Locations

4140 Ferncreek Dr
Ste 300
Fayetteville, NC 28314
Phone (910) 321-6006

1521 Owen Park Ln
Fayetteville, NC 28304
Phone (910) 223-7420

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1801126909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 OWEN PARK LN",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043454",
            "telephone_number": "910-321-6006",
            "fax_number": "877-795-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 OWEN PARK LN",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043454",
            "telephone_number": "910-321-6006",
            "fax_number": "877-795-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANT",
        "first_name": "TIMOTHY",
        "credential": "LPC, LCAS, CSI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-12",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "8839",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1876",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "8839",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "8839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6601052",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIM",
            "last_name": "GANT",
            "credential": "LPC, LCAS, ICAADC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.