Individual
MS. JILL M LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED. LAC
Contact information
Practice address
1445 1ST AVE N, FARGO, ND 58102
(701) 261-3113
(701) 298-3497
Mailing address
1445 1ST AVE N, FARGO, ND 58102
(701) 261-3113
(701) 298-3496
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ND1439
ND
Other
Enumeration date
09/15/2008
Last updated
09/15/2008
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