Provider Demographics
NPI:1871141077
Name:LAGASSE, ALAINE VIOLA
Entity type:Individual
Prefix:
First Name:ALAINE
Middle Name:VIOLA
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KENAI VET CENTER
Mailing Address - Street 2:43299 KALIFORNSKY BEACH ROAD STE 4
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669
Mailing Address - Country:US
Mailing Address - Phone:907-260-7640
Mailing Address - Fax:907-260-7642
Practice Address - Street 1:KENAI VET CENTER
Practice Address - Street 2:43299 KALIFORNSKY BEACH ROAD STE 4
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-260-7640
Practice Address - Fax:907-260-7642
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121549101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor