MEDICARE: THE CAVIN GROUP, LLC

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	103K00000X	Behavior Analyst	1-12-12287
2	101YP2500X	Professional Counselor	LPC006387	GA

General Provider Information

NPI Number	:	1689985566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CAVIN GROUP, LLC

Provider Business Mailing Address
First Line	:	3330 CUMBERLAND BLVD
Second Line	:	SUITE 500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5995
Country	:	US
Telephone Number	:	866-278-3194
Fax Number	:	866-278-3194

Provider Business Practice Location Address
First Line	:	3330 CUMBERLAND BLVD
Second Line	:	SUITE 500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5995
Country	:	US
Telephone Number	:	866-278-3194
Fax Number	:	866-278-3194

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JASON TODD CAVIN
Credential	:	MS, MA
Telephone Number	:	866-278-3194

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	09/17/2014

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