Provider Demographics
NPI:1114470762
Name:LAVIOLETTE, BEAU MICHAELS I (LCSW, LAC)
Entity Type:Individual
Prefix:MR
First Name:BEAU
Middle Name:MICHAELS
Last Name:LAVIOLETTE
Suffix:I
Gender:M
Credentials:LCSW, LAC
Other - Prefix:MR
Other - First Name:BEAU
Other - Middle Name:MICHAELS
Other - Last Name:LAVIOLETTE
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LAC
Mailing Address - Street 1:13131 WOODRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5209
Mailing Address - Country:US
Mailing Address - Phone:504-261-8654
Mailing Address - Fax:
Practice Address - Street 1:11843 BRICKSOME AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5310
Practice Address - Country:US
Practice Address - Phone:504-261-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1401101YA0400X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)