Provider Demographics
NPI:1649959644
Name:GOBBLE, TREVOR RYNE (RESIDENT COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:RYNE
Last Name:GOBBLE
Suffix:
Gender:M
Credentials:RESIDENT COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 BY PASS RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-1835
Mailing Address - Country:US
Mailing Address - Phone:540-767-2667
Mailing Address - Fax:540-767-2669
Practice Address - Street 1:1120 BY PASS RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1835
Practice Address - Country:US
Practice Address - Phone:540-767-2667
Practice Address - Fax:540-767-2669
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional