Provider Demographics
NPI:1255170445
Name:BROWN, GAVRA ELIZABETH (LMHP-R)
Entity type:Individual
Prefix:
First Name:GAVRA
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CLAYBANKS DR
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24067-4528
Mailing Address - Country:US
Mailing Address - Phone:540-589-8646
Mailing Address - Fax:
Practice Address - Street 1:940 CLAYBANKS DR
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:VA
Practice Address - Zip Code:24067-4528
Practice Address - Country:US
Practice Address - Phone:540-589-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245342823Medicaid