Healthcare Provider Details

I. General information

NPI: 1891929360
Provider Name (Legal Business Name): ROBERT MITCHELL GAVIN PHD, (ABD),
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 PERRY ST NE G-1
WASHINGTON DC
20017-2550
US

IV. Provider business mailing address

1218 PERRY ST NE G-1
WASHINGTON DC
20017-2550
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8403
  • Fax: 202-832-8403
Mailing address:
  • Phone: 202-832-8403
  • Fax: 202-832-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPRC-1218
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberM1220-2005
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number203292
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number013305
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC1218
License Number StateDC
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC-1218
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6731
License Number StateDC
# 8
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number6731
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: