Healthcare Provider Details

I. General information

NPI: 1700390929
Provider Name (Legal Business Name): CHRISTIAN JAMES GABRANO ACIT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 LUCAS PKWY
LOWELL IN
46356-2169
US

IV. Provider business mailing address

206 MADISON ST
VALPARAISO IN
46385-4539
US

V. Phone/Fax

Practice location:
  • Phone: 219-690-7025
  • Fax:
Mailing address:
  • Phone: 219-789-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: