Provider Demographics
NPI:1508387416
Name:AVANT, IVORY MONIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:IVORY
Middle Name:MONIQUE
Last Name:AVANT
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 1:1882 CAPITAL CIR NE STE 205
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4568
Mailing Address - Country:US
Mailing Address - Phone:888-718-4915
Mailing Address - Fax:850-765-7597
Practice Address - Street 1:1882 CAPITAL CIR NE STE 205
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4568
Practice Address - Country:US
Practice Address - Phone:888-718-4915
Practice Address - Fax:850-765-7597
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
FLSW174391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251B00000XAgenciesCase Management