Healthcare Provider Details

I. General information

NPI: 1033644745
Provider Name (Legal Business Name): DR. MELCHESSADECH CLARICE LAVIGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 WESTBROOK DR
BATON ROUGE LA
70815-6279
US

IV. Provider business mailing address

2134 GENERAL CLEBURNE AVE
BATON ROUGE LA
70810-6862
US

V. Phone/Fax

Practice location:
  • Phone: 225-993-9422
  • Fax:
Mailing address:
  • Phone: 225-993-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number53607
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: