Provider Demographics
NPI:1497972160
Name:MAROVIC-JOHNSON, DAVORKA (LPC)
Entity Type:Individual
Prefix:
First Name:DAVORKA
Middle Name:
Last Name:MAROVIC-JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S BEMISTON AVE STE 1213
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1907
Mailing Address - Country:US
Mailing Address - Phone:314-406-7281
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 1213
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-406-7281
Practice Address - Fax:314-406-7281
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002032346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO562376877OtherCOUNSELING
MO499061604Medicaid