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General NPI Number Information
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NPI Number | 1265774905
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Entity Type | Individual
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Provider Name | ADELE LAVIGNE LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 25 S GRAFTON ST
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City | ROMNEY
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State | WV
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Zip | 26757-1802
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Country | US
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Telephone | 304-851-5432
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844
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City | ROMNEY
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State | WV
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Zip | 26757-0844
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Country | US
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Telephone | 304-851-5432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00942334
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License Number State | WV
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