Provider Demographics
NPI:1093166613
Name:LAVON M. GAINEY
Entity Type:Organization
Organization Name:LAVON M. GAINEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVON
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:GAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-284-8005
Mailing Address - Street 1:3401 VOLLEY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-9345
Mailing Address - Country:US
Mailing Address - Phone:407-284-8005
Mailing Address - Fax:
Practice Address - Street 1:11265 ALUMNI WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6685
Practice Address - Country:US
Practice Address - Phone:904-518-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 101YM0800X
FLMH13303320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH13303OtherMENTAL HEALTH THERAPIST