Provider Demographics
NPI:1093447963
Name:FLOURNOY, LAVERGNE SHENEE (RBT)
Entity Type:Individual
Prefix:MS
First Name:LAVERGNE
Middle Name:SHENEE
Last Name:FLOURNOY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 50TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5019
Mailing Address - Country:US
Mailing Address - Phone:619-674-5509
Mailing Address - Fax:
Practice Address - Street 1:10680 TREENA ST STE 170
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2443
Practice Address - Country:US
Practice Address - Phone:858-432-4749
Practice Address - Fax:858-432-4750
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15-10682106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician