Provider Demographics
NPI:1174836480
Name:FLETCHER, LAVON (LCSW)
Entity Type:Individual
Prefix:
First Name:LAVON
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W VAN BUREN ST
Mailing Address - Street 2:STE F
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-2060
Mailing Address - Country:US
Mailing Address - Phone:260-244-5690
Mailing Address - Fax:844-776-0360
Practice Address - Street 1:202 W VAN BUREN ST
Practice Address - Street 2:STE F
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-2060
Practice Address - Country:US
Practice Address - Phone:260-636-6884
Practice Address - Fax:260-636-3392
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005087A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical