Provider Demographics
NPI:1508525429
Name:WATERS, LAVONDA YVETTE (MS)
Entity Type:Individual
Prefix:MS
First Name:LAVONDA
Middle Name:YVETTE
Last Name:WATERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 PATSY ANN CT S
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3357
Mailing Address - Country:US
Mailing Address - Phone:229-894-0637
Mailing Address - Fax:
Practice Address - Street 1:1873 PATSY ANN CT S
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3357
Practice Address - Country:US
Practice Address - Phone:229-894-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health