Provider Demographics
NPI:1811290075
Name:DEVEREAUX, LYNNETTA LAVONNE (IMF)
Entity type:Individual
Prefix:
First Name:LYNNETTA
Middle Name:LAVONNE
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:LYNNETTA
Other - Middle Name:LAVONNE
Other - Last Name:DEVEREAUX-JETER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:864 N 2ND ST STE 369
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5806
Mailing Address - Country:US
Mailing Address - Phone:858-829-5917
Mailing Address - Fax:
Practice Address - Street 1:7364 EL CAJON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1866
Practice Address - Country:US
Practice Address - Phone:858-829-5917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist