Provider Demographics
NPI:1003550179
Name:KING, LAVONNE LEE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LAVONNE
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTERPOINTE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8696
Mailing Address - Country:US
Mailing Address - Phone:971-213-2837
Mailing Address - Fax:971-209-7260
Practice Address - Street 1:5 CENTERPOINTE DR STE 320
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8696
Practice Address - Country:US
Practice Address - Phone:971-213-2837
Practice Address - Fax:971-209-7260
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA13468104100000X
OR23-QMHPC-001334101YM0800X
ORL164741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5008069107Medicaid