Provider Demographics
NPI:1497512578
Name:SALLEY, LAVONIA DENISE (BSW)
Entity Type:Individual
Prefix:MRS
First Name:LAVONIA
Middle Name:DENISE
Last Name:SALLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4782 MCGILL CT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-6001
Mailing Address - Country:US
Mailing Address - Phone:175-758-9370
Mailing Address - Fax:
Practice Address - Street 1:4782 MCGILL CT
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-6001
Practice Address - Country:US
Practice Address - Phone:757-589-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program