Healthcare Provider Details

I. General information

NPI: 1407797202
Provider Name (Legal Business Name): MICHAEL LAWRENCE LAJEUNESSE JR. CADC-1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 E LOS ANGELES AVE STE B2
SIMI VALLEY CA
93065-1884
US

IV. Provider business mailing address

84 W BROADWAY STE 200
DERRY NH
03038-2323
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-1844
  • Fax:
Mailing address:
  • Phone: 603-513-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI43710724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: