Provider Information for 1528677325
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GAVIN B CHADWELL LCMHC
Sex: Male
NPI: 1528677325
Last Updated: 2021-07-23
Certification Date: 2021-07-23
Certification Date: 2021-07-23
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1528677325 | ||||||||||||
| Enumeration Date | 2020-07-28 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 44 READ RD WILLISTON, VT 05495-8101 United States Phone: 802-556-1441 | Fax: | ||||||||||||
| Primary Practice Address | 44 READ RD WILLISTON, VT 05495-8101 United States Phone: 802-552-8124 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 337 COLLEGE ST STE G | ||||||||||||
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