Provider Demographics
NPI:1871832063
Name:GAVITT, PAULA (LPA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:GAVITT
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-8896
Mailing Address - Country:US
Mailing Address - Phone:336-372-2530
Mailing Address - Fax:336-372-2532
Practice Address - Street 1:393 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-8896
Practice Address - Country:US
Practice Address - Phone:336-372-2530
Practice Address - Fax:336-372-2532
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical