Provider Demographics
NPI:1578609715
Name:WOODWARD, MICHELLE LAVOIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LAVOIE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:DENISE
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 PHILLIPS LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-3125
Mailing Address - Country:US
Mailing Address - Phone:781-526-5481
Mailing Address - Fax:
Practice Address - Street 1:1051 POST RD STE 1
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5436
Practice Address - Country:US
Practice Address - Phone:781-526-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1398101YM0800X
MA5688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health