Provider Demographics
NPI:1548985070
Name:ODINGO, LAVONA E (MA, LMHCA)
Entity type:Individual
Prefix:MRS
First Name:LAVONA
Middle Name:E
Last Name:ODINGO
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 86TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-8527
Mailing Address - Country:US
Mailing Address - Phone:212-961-7823
Mailing Address - Fax:425-771-8400
Practice Address - Street 1:3305 OAKES AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4409
Practice Address - Country:US
Practice Address - Phone:425-236-5520
Practice Address - Fax:425-771-8400
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61349368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health