Provider Demographics
NPI:1487345914
Name:GAVGAVIAN, WILLIAM STEVEN
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STEVEN
Last Name:GAVGAVIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BLUE WING DR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2102
Mailing Address - Country:US
Mailing Address - Phone:707-290-6033
Mailing Address - Fax:
Practice Address - Street 1:201 ALAMEDA DEL PRADO
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6688
Practice Address - Country:US
Practice Address - Phone:415-491-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health