Provider Demographics
NPI:1225216385
Name:WEAVER, LAVINA MILLER (PCC)
Entity Type:Individual
Prefix:
First Name:LAVINA
Middle Name:MILLER
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:10470 WINESBURG ROAD
Mailing Address - City:MOUNT EATON
Mailing Address - State:OH
Mailing Address - Zip Code:44659-0265
Mailing Address - Country:US
Mailing Address - Phone:330-359-6100
Mailing Address - Fax:330-319-7381
Practice Address - Street 1:10470 WINESBURG RD
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OH
Practice Address - Zip Code:44624-9442
Practice Address - Country:US
Practice Address - Phone:330-359-6100
Practice Address - Fax:330-319-7381
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional