Healthcare Provider Details

I. General information

NPI: 1477691020
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL LAVIN L.A.D.C., L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

IMA EUROPE UNIT 29353 BOX 200
APO AE
09014
US

IV. Provider business mailing address

IMA EUROPE UNIT 29353 BOX 200
APO AE
09014
US

V. Phone/Fax

Practice location:
  • Phone: 496-221-5789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC506
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: