| NPI | 1114470762 |
|---|---|
| Other Name | BEAU MICHAELS LAVIOLETTE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1401) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2019-07-24 |