Provider Demographics
NPI:1366722589
Name:DUBLIN, AVIS J (MSW, LCSW, P-LCAS)
Entity type:Individual
Prefix:
First Name:AVIS
Middle Name:J
Last Name:DUBLIN
Suffix:
Gender:F
Credentials:MSW, LCSW, P-LCAS
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 41513
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27629-1513
Mailing Address - Country:US
Mailing Address - Phone:919-632-8111
Mailing Address - Fax:
Practice Address - Street 1:100 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-6767
Practice Address - Country:US
Practice Address - Phone:919-632-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0073951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical