Provider Demographics
NPI:1992582910
Name:ST VOLTAIRE INC
Entity type:Organization
Organization Name:ST VOLTAIRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTORAL
Authorized Official - Prefix:
Authorized Official - First Name:LAVAR
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-975-9216
Mailing Address - Street 1:489 DEWDROP CIR APT C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3799
Mailing Address - Country:US
Mailing Address - Phone:513-975-9216
Mailing Address - Fax:
Practice Address - Street 1:489 DEWDROP CIR APT C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3799
Practice Address - Country:US
Practice Address - Phone:513-975-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty