Provider Demographics
NPI:1649231242
Name:LAVEIGNE, JOELLEN (LMHC)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:LAVEIGNE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3942 SW 97TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4667
Mailing Address - Country:US
Mailing Address - Phone:352-333-0127
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:3942 SW 97TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4667
Practice Address - Country:US
Practice Address - Phone:352-333-0127
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 1286103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent