Organization
NORTHWEST CHILD AND FAMILY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARON BAST GAVORA PSY.D. (PRESIDENT)
(503) 636-4333
Entity
Organization
Contact information
Practice address
14619 NE 82ND AVE, VANCOUVER, WA 98662-1057
(503) 636-4333
Mailing address
14619 NE 82ND AVE, VANCOUVER, WA 98662-1057
(503) 636-4333
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1373
OR
103TC0700X
Clinical Psychologist
Primary
TE00003919
WA
Other
Enumeration date
04/03/2007
Last updated
03/07/2008
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