Provider Demographics
NPI:1821984139
Name:LOVELACE, JOVAN ANTRANATTE
Entity type:Individual
Prefix:
First Name:JOVAN
Middle Name:ANTRANATTE
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 AL JENNAH BLVD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3753
Mailing Address - Country:US
Mailing Address - Phone:765-398-9640
Mailing Address - Fax:
Practice Address - Street 1:179 AL JENNAH BLVD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3753
Practice Address - Country:US
Practice Address - Phone:765-398-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-319619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty