Provider Demographics
NPI:1528677325
Name:CHADWELL, GAVIN B (LCMHC)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:B
Last Name:CHADWELL
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 READ RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8101
Mailing Address - Country:US
Mailing Address - Phone:802-556-1441
Mailing Address - Fax:
Practice Address - Street 1:44 READ RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8101
Practice Address - Country:US
Practice Address - Phone:802-552-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134358101YM0800X
VT068.0134241-EMGY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty