Provider Demographics
NPI:1528380144
Name:SPIVEY, JAVONNE L
Entity Type:Individual
Prefix:
First Name:JAVONNE
Middle Name:L
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13374 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3801
Mailing Address - Country:US
Mailing Address - Phone:330-671-7255
Mailing Address - Fax:
Practice Address - Street 1:13374 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3801
Practice Address - Country:US
Practice Address - Phone:330-671-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health