Provider Demographics
NPI:1063425122
Name:LAVOO, ABIGAIL W (PHD LPC LAC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:W
Last Name:LAVOO
Suffix:
Gender:F
Credentials:PHD LPC LAC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:WITHER
Other - Last Name:WITHERS LAVOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LAC
Mailing Address - Street 1:6660 DELMONICO DR D210
Mailing Address - Street 2:
Mailing Address - City:COLO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-298-3343
Mailing Address - Fax:303-532-5079
Practice Address - Street 1:7660 GODDARD ST STE 234
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8231
Practice Address - Country:US
Practice Address - Phone:719-298-3343
Practice Address - Fax:303-532-5079
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3980LPC101Y00000X
CO232LAC101YA0400X
CO6360101YA0400X
COLAC101YA0400X
COLAC232101YM0800X
CO3980101YP1600X, 101YP2500X
CO3980-LPC101YP2500X
COLPC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28632508Medicaid