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NPI Code Detail

MEDICARE: JACQUELYN LAVENDER LCDC III

MEDICARE: JACQUELYN LAVENDER LCDC III
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.162533OH

General Provider Information

NPI Number : 1902357973
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN LAVENDER LCDC III
Provider Business Mailing Address
First Line : 1455 S 4TH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1011
Country : US
Telephone Number : 614-444-0800
Fax Number : 614-444-1036
Provider Business Practice Location Address
First Line : 1455 S 4TH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1011
Country : US
Telephone Number : 614-444-0800
Fax Number : 614-444-1036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2016
Last Update Date : 07/09/2024

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