Provider Demographics
NPI:1740995679
Name:LAVENDER, SHONNIE LYN (LCMHCA)
Entity type:Individual
Prefix:
First Name:SHONNIE
Middle Name:LYN
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ZILLICOA ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1038
Mailing Address - Country:US
Mailing Address - Phone:828-778-2871
Mailing Address - Fax:
Practice Address - Street 1:223 E CHESTNUT ST STE 4
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2480
Practice Address - Country:US
Practice Address - Phone:828-400-6299
Practice Address - Fax:828-484-4912
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional