Healthcare Provider Details

I. General information

NPI: 1215673256
Provider Name (Legal Business Name): LAVNI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 S GARNETT ST
HENDERSON NC
27536-4571
US

IV. Provider business mailing address

804 S GARNETT ST
HENDERSON NC
27536-4571
US

V. Phone/Fax

Practice location:
  • Phone: 980-890-7522
  • Fax: 980-890-7814
Mailing address:
  • Phone: 980-890-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARCUS AZEH
Title or Position: INCORPORATOR
Credential:
Phone: 843-460-4292