Healthcare Provider Details

I. General information

NPI: 1548345713
Provider Name (Legal Business Name): ALLAN L LAVOIE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 3RD ST
ELKINS WV
26241-3831
US

IV. Provider business mailing address

PO BOX 2016
ELKINS WV
26241-2016
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-1811
  • Fax: 304-637-7299
Mailing address:
  • Phone: 304-636-1811
  • Fax: 304-637-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: