Provider Demographics
NPI:1538569322
Name:LAFONTAINE, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LAFONTAINE
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 1:1945 NE 205TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-9622
Mailing Address - Country:US
Mailing Address - Phone:503-661-8050
Mailing Address - Fax:
Practice Address - Street 1:1945 NE 205TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-9622
Practice Address - Country:US
Practice Address - Phone:503-661-8050
Practice Address - Fax:503-492-4651
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health