Provider Demographics
NPI:1861941114
Name:GAINEY, LAVON M
Entity type:Individual
Prefix:MS
First Name:LAVON
Middle Name:M
Last Name:GAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAVON
Other - Middle Name:M
Other - Last Name:GAINEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:11265 ALUMNI WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6685
Mailing Address - Country:US
Mailing Address - Phone:904-398-2020
Mailing Address - Fax:904-724-2172
Practice Address - Street 1:11265 ALUMNI WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6685
Practice Address - Country:US
Practice Address - Phone:904-398-2020
Practice Address - Fax:904-724-2172
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH13303OtherLICENSURE