Provider Demographics
NPI:1679151880
Name:PAVONE, WINTER (LPC-MHSP (TEMPORARY))
Entity Type:Individual
Prefix:
First Name:WINTER
Middle Name:
Last Name:PAVONE
Suffix:
Gender:F
Credentials:LPC-MHSP (TEMPORARY)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3121
Mailing Address - Country:US
Mailing Address - Phone:615-383-1995
Mailing Address - Fax:615-292-1919
Practice Address - Street 1:602 W IRIS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3121
Practice Address - Country:US
Practice Address - Phone:615-383-1995
Practice Address - Fax:615-292-1919
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional