Provider Demographics
NPI:1194396887
Name:BROWN, LAVONIA ROCHELLE (RBT)
Entity type:Individual
Prefix:
First Name:LAVONIA
Middle Name:ROCHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 BUSINESS PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1428
Mailing Address - Country:US
Mailing Address - Phone:770-884-1050
Mailing Address - Fax:
Practice Address - Street 1:3070 BUSINESS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1428
Practice Address - Country:US
Practice Address - Phone:770-884-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-164470106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician