Provider Demographics
NPI:1700212149
Name:SPAIN, LAVERNA HOLWILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAVERNA
Middle Name:HOLWILL
Last Name:SPAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 83RD AVE SW STE F
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6078
Mailing Address - Country:US
Mailing Address - Phone:253-345-4281
Mailing Address - Fax:253-302-5989
Practice Address - Street 1:8404 83RD AVE SW STE F
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498
Practice Address - Country:US
Practice Address - Phone:253-345-4581
Practice Address - Fax:253-302-5989
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60397933101Y00000X, 103T00000X
FL17377101YP1600X, 106H00000X
WA0064101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist