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General NPI Number Information
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NPI Number | 1013391564
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Entity Type | Organization
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Legal Business Name | GAVIN CONNOR, L.P.C.
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 700 HARRIS ST STE 106
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4584
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Country | US
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Telephone | 434-249-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 700 HARRIS ST STE 106
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4584
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Country | US
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Telephone | 434-249-0230
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | GAVIN CONNOR
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Credential | L.P.C.
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Telephone | 434-249-0230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701005444
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License Number State | VA
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