Provider Demographics
NPI:1871162677
Name:ANITA LAVIOLA, LCSW,CSAC LLC
Entity type:Organization
Organization Name:ANITA LAVIOLA, LCSW,CSAC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LAVIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC
Authorized Official - Phone:808-281-2340
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-1052
Mailing Address - Country:US
Mailing Address - Phone:808-264-4457
Mailing Address - Fax:
Practice Address - Street 1:2200 MAIN ST STE 528
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1640
Practice Address - Country:US
Practice Address - Phone:808-281-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty