Provider Demographics
NPI:1356799332
Name:LAVIGNE, DAN D (BS, LADC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:D
Last Name:LAVIGNE
Suffix:
Gender:M
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MOAT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5605
Mailing Address - Country:US
Mailing Address - Phone:603-730-7041
Mailing Address - Fax:
Practice Address - Street 1:3957 MAIN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:NH
Practice Address - Zip Code:03574
Practice Address - Country:US
Practice Address - Phone:603-869-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0984101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)