Provider Demographics
NPI:1013391564
Name:GAVIN CONNOR, L.P.C.
Entity Type:Organization
Organization Name:GAVIN CONNOR, L.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-249-0230
Mailing Address - Street 1:700 HARRIS ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4584
Mailing Address - Country:US
Mailing Address - Phone:434-249-0230
Mailing Address - Fax:
Practice Address - Street 1:700 HARRIS ST STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4584
Practice Address - Country:US
Practice Address - Phone:434-249-0230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005444251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health