Provider Demographics
NPI:1245576230
Name:DAIGLE, MICHELLE FONTENOT (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FONTENOT
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 GREEN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6104
Mailing Address - Country:US
Mailing Address - Phone:337-216-3336
Mailing Address - Fax:
Practice Address - Street 1:113 CHAPLIN DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2101
Practice Address - Country:US
Practice Address - Phone:337-521-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4578104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker