Provider Demographics
NPI:1588848741
Name:LAVERDURE, ANDREA E (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:LAVERDURE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0650
Mailing Address - Country:US
Mailing Address - Phone:701-477-8272
Mailing Address - Fax:701-477-8271
Practice Address - Street 1:113 MAIN AVE E
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367
Practice Address - Country:US
Practice Address - Phone:701-477-8272
Practice Address - Fax:701-477-8271
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND41211198101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor