Provider Demographics
NPI:1093553786
Name:GAULDING, LEVAR LEE (RADT)
Entity type:Individual
Prefix:
First Name:LEVAR
Middle Name:LEE
Last Name:GAULDING
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 CLAYTON RD APT 7
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2523
Mailing Address - Country:US
Mailing Address - Phone:925-435-5126
Mailing Address - Fax:
Practice Address - Street 1:3916 CLAYTON RD APT 7
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2523
Practice Address - Country:US
Practice Address - Phone:925-435-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)