Provider Demographics
NPI:1932712064
Name:KINDLE, LAVANA J (MS, MED, LAC)
Entity Type:Individual
Prefix:MRS
First Name:LAVANA
Middle Name:J
Last Name:KINDLE
Suffix:
Gender:F
Credentials:MS, MED, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 HWY 278 W
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-8901
Mailing Address - Country:US
Mailing Address - Phone:870-818-8714
Mailing Address - Fax:
Practice Address - Street 1:VICTORY CHURCH 1283 US-278 W
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4551
Practice Address - Country:US
Practice Address - Phone:870-818-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2006085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional