Healthcare Provider Details

I. General information

NPI: 1689985566
Provider Name (Legal Business Name): THE CAVIN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CUMBERLAND BLVD SUITE 500
ATLANTA GA
30339-5995
US

IV. Provider business mailing address

3330 CUMBERLAND BLVD SUITE 500
ATLANTA GA
30339-5995
US

V. Phone/Fax

Practice location:
  • Phone: 866-278-3194
  • Fax: 866-278-3194
Mailing address:
  • Phone: 866-278-3194
  • Fax: 866-278-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006387
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-12287
License Number State

VIII. Authorized Official

Name: JASON TODD CAVIN
Title or Position: DIRECTOR
Credential: MS, MA
Phone: 866-278-3194