Provider Demographics
NPI:1568755338
Name:SANTANGELO, LAVERNE (LLPC)
Entity Type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:
Last Name:SANTANGELO
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 GARRY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2359
Mailing Address - Country:US
Mailing Address - Phone:586-945-4949
Mailing Address - Fax:
Practice Address - Street 1:2143 GARRY DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2359
Practice Address - Country:US
Practice Address - Phone:586-945-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional