MEDICARE: LAVONDA ROCHELLE KNOX LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5118	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588995799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVONDA ROCHELLE KNOX LPC

Provider Business Mailing Address
First Line	:	4221 MAYFAIR ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5757
Country	:	US
Telephone Number	:	843-455-0558
Fax Number	:	843-236-9481

Provider Business Practice Location Address
First Line	:	4221 MAYFAIR ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5757
Country	:	US
Telephone Number	:	843-455-0558
Fax Number	:	843-236-9481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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