Provider Demographics
NPI:1629203542
Name:JOHNSON, LAVONNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAVONNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:LAVONNE
Other - Middle Name:DESIREE MIRICAL
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSMFT
Mailing Address - Street 1:1784 W NORTHFIELD BLVD # 363
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1702
Mailing Address - Country:US
Mailing Address - Phone:615-440-9952
Mailing Address - Fax:855-531-0056
Practice Address - Street 1:2615 MEDICAL CENTER PARKWAY
Practice Address - Street 2:SUITE 1560
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1702
Practice Address - Country:US
Practice Address - Phone:615-440-9952
Practice Address - Fax:855-531-0056
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist