Provider Demographics
NPI:1366570749
Name:CHANDLER, GAVIC JAACOB (MA)
Entity type:Individual
Prefix:MR
First Name:GAVIC
Middle Name:JAACOB
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37041-0006
Mailing Address - Country:US
Mailing Address - Phone:931-206-7356
Mailing Address - Fax:931-260-7332
Practice Address - Street 1:810 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4068
Practice Address - Country:US
Practice Address - Phone:931-206-7257
Practice Address - Fax:931-260-7332
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00029571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health