Provider Demographics
NPI:1700665015
Name:LAVERNE SANTANGELO
Entity Type:Organization
Organization Name:LAVERNE SANTANGELO
Other - Org Name:LAVERNE SANTANGELO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVERNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:586-945-4949
Mailing Address - Street 1:48048 BURTON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-2406
Mailing Address - Country:US
Mailing Address - Phone:586-945-4949
Mailing Address - Fax:
Practice Address - Street 1:48048 BURTON DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-2406
Practice Address - Country:US
Practice Address - Phone:586-945-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty