Provider Demographics
NPI:1295309771
Name:NEVINS, LAQUARRIA S (LMSW)
Entity type:Individual
Prefix:
First Name:LAQUARRIA
Middle Name:S
Last Name:NEVINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 TALIAFERRO TRL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7758
Mailing Address - Country:US
Mailing Address - Phone:334-451-1335
Mailing Address - Fax:
Practice Address - Street 1:1711 TALIAFERRO TRL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7758
Practice Address - Country:US
Practice Address - Phone:334-451-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5230G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker