Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1255479267 |
---|---|
Provider Name | Mr. Gavin Randall Hitchins |
First Address | Champaign, IL 61821-3140 |
Second Address | Champaign, IL 61820-7236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |