Provider Demographics
NPI:1306438908
Name:LAVIGNE, MARIE JEANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:JEANNE
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:LCSW
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 210044
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521-0044
Mailing Address - Country:US
Mailing Address - Phone:907-240-2482
Mailing Address - Fax:
Practice Address - Street 1:6703 LUNAR DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4575
Practice Address - Country:US
Practice Address - Phone:907-240-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical