Provider Demographics
NPI:1124698014
Name:KING-BROWN, LAVERNA NICOLE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:LAVERNA
Middle Name:NICOLE
Last Name:KING-BROWN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 LAKE DR SE UNIT 68426
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49516-5058
Mailing Address - Country:US
Mailing Address - Phone:810-814-3000
Mailing Address - Fax:
Practice Address - Street 1:3575 BURTON ST SE # TAU2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7681
Practice Address - Country:US
Practice Address - Phone:616-710-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical