Provider Demographics
NPI:1265774905
Name:LAVIGNE, ADELE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-0844
Mailing Address - Country:US
Mailing Address - Phone:304-851-5432
Mailing Address - Fax:
Practice Address - Street 1:25 S GRAFTON ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1802
Practice Address - Country:US
Practice Address - Phone:304-851-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009423341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical