MEDICARE: SHONNIE LYN LAVENDER LCMHCA

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	101YP2500X	Professional Counselor	A18419	NC

General Provider Information

NPI Number	:	1740995679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONNIE LYN LAVENDER LCMHCA

Provider Business Mailing Address
First Line	:	1 ZILLICOA ST
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-1038
Country	:	US
Telephone Number	:	828-778-2871
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E CHESTNUT ST STE 4
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2480
Country	:	US
Telephone Number	:	828-400-6299
Fax Number	:	828-484-4912

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

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	05/22/2024

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