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General NPI Number Information
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NPI Number | 1821878059
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Entity Type | Individual
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Provider Name | GAVIN KNOBLOCH CADC I CI37960323
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Gender | Male
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 351 MALL DR
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City | HANFORD
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State | CA
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Zip | 93230-5950
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Country | US
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Telephone | 559-978-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 5754 W ELLERY AVE
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City | FRESNO
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State | CA
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Zip | 93722-3144
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Country | US
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Telephone | 559-645-2882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CI37960323
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License Number State | CA
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