Provider Demographics
NPI:1770179046
Name:GOKAS, CHAZ (LADC)
Entity type:Individual
Prefix:
First Name:CHAZ
Middle Name:
Last Name:GOKAS
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5457
Mailing Address - Country:US
Mailing Address - Phone:207-767-0991
Mailing Address - Fax:207-767-0995
Practice Address - Street 1:525 MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5457
Practice Address - Country:US
Practice Address - Phone:207-767-0991
Practice Address - Fax:207-767-0995
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5387101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)