Provider Demographics
NPI:1417436346
Name:LAFAVE, ALISON MARIE
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:LAFAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2809
Mailing Address - Country:US
Mailing Address - Phone:616-942-2522
Mailing Address - Fax:
Practice Address - Street 1:301 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2134
Practice Address - Country:US
Practice Address - Phone:906-635-5542
Practice Address - Fax:888-977-2109
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician