Individual
DR. LAVONDA K MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5801 ARMY PENTAGON CORRIDOR 8, ROOM 130, WASHINGTON, DC 20301-5801
(703) 614-6562
Mailing address
5801 ARMY PENTAGON CORRIDOR 8, ROOM 130, WASHINGTON, DC 20301-5801
(703) 614-6562
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
25833
CA
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Enumeration date
11/22/2008
Last updated
08/16/2023
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