Healthcare Provider Details

I. General information

NPI: 1740821339
Provider Name (Legal Business Name): FARRAH LAVIOLETTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 ALLEN DR STE I
TROY MI
48083-4009
US

IV. Provider business mailing address

1407 ALLEN DR STE I
TROY MI
48083-4009
US

V. Phone/Fax

Practice location:
  • Phone: 248-971-0420
  • Fax: 248-780-3786
Mailing address:
  • Phone: 248-971-0420
  • Fax: 248-780-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number4351046857
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301508678
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301508678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: