Provider Demographics
NPI:1639814122
Name:DONNISHA LAVIGNE LLC
Entity Type:Organization
Organization Name:DONNISHA LAVIGNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNISHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAVIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-452-6117
Mailing Address - Street 1:6691 CHURCH ST UNIT 962095
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-4083
Mailing Address - Country:US
Mailing Address - Phone:470-452-6117
Mailing Address - Fax:
Practice Address - Street 1:3863 HIGHWAY 138 SE # 1082
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4143
Practice Address - Country:US
Practice Address - Phone:470-452-6117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty