Provider Demographics
NPI:1720389349
Name:LAVAIRE, ARNOLD ADALID (LCPC)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:ADALID
Last Name:LAVAIRE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 PELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1743
Mailing Address - Country:US
Mailing Address - Phone:708-838-4031
Mailing Address - Fax:630-682-5276
Practice Address - Street 1:1530 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3512
Practice Address - Country:US
Practice Address - Phone:630-653-6400
Practice Address - Fax:630-682-5276
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional