Healthcare Provider Details

I. General information

NPI: 1174076368
Provider Name (Legal Business Name): MELISSA LYNN LAVOIE BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA LYNN LAVOIE BCBA, LBA

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7165 COLUMBIA GATEWAY DR
COLUMBIA MD
21046-2539
US

IV. Provider business mailing address

4703 MOUNT ZION RD
FREDERICK MD
21703-5925
US

V. Phone/Fax

Practice location:
  • Phone: 443-243-7647
  • Fax:
Mailing address:
  • Phone: 302-354-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000786
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: