Provider Demographics
NPI:1679847156
Name:LIGGINS, LAVETHE ROAITIA
Entity Type:Individual
Prefix:MS
First Name:LAVETHE
Middle Name:ROAITIA
Last Name:LIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 BOONE AVE N. #108
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428
Mailing Address - Country:US
Mailing Address - Phone:612-238-2360
Mailing Address - Fax:612-871-2567
Practice Address - Street 1:2616 NICOLLET AVE SOUTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-0900
Practice Address - Country:US
Practice Address - Phone:612-871-7878
Practice Address - Fax:612-871-2567
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor