Basic Information
Provider Information
NPI: 1881174837
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAINES
FirstName: CHAVONNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.ED., LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5188 GOODISON PARK RD UNIT 204
Address2:  
City: WESTERVILLE
State: OH
PostalCode: 430817683
CountryCode: US
TelephoneNumber: 3306960591
FaxNumber:  
Practice Location
Address1: 299 CRAMER CREEK CT
Address2:  
City: DUBLIN
State: OH
PostalCode: 430172586
CountryCode: US
TelephoneNumber: 6148895722
FaxNumber: 6148899335
Other Information
ProviderEnumerationDate: 08/20/2018
LastUpdateDate: 08/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XC.1801545OHY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home