Healthcare Provider Details

I. General information

NPI: 1396606943
Provider Name (Legal Business Name): AMANDA PURDY LAVOIE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 KERRY ST
LANSING MI
48912-3658
US

IV. Provider business mailing address

9335 LOOKOUT POINT DR
LAINGSBURG MI
48848-9743
US

V. Phone/Fax

Practice location:
  • Phone: 734-926-5537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121293
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: