Provider Demographics
NPI:1831347350
Name:LAVIGNA, PAMELA MARIE (MA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:LAVIGNA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:TOBIN-SACHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:COUNSELING & DISABILITY SERVICES, LLC.
Mailing Address - Street 2:1635 S. RIDGEWOOD AVE SUITE 225
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119
Mailing Address - Country:US
Mailing Address - Phone:203-980-5713
Mailing Address - Fax:386-788-5021
Practice Address - Street 1:1635 S. RIDGEWOOD AVE, SUITE 225
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119
Practice Address - Country:US
Practice Address - Phone:386-788-5021
Practice Address - Fax:386-788-5021
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001672101YP2500X
FL17360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional