Basic Information
| Provider Information | |||||||||
| NPI: | 1245976778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LABONTE | ||||||||
| FirstName: | VASILIKI | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | LABONTE | ||||||||
| OtherFirstName: | VICTORIA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16837 HIGHLAND HEIGHTS DR | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704355662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852739764 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11408 LAKE SHERWOOD AVE N STE A | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708160421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252617143 | ||||||||
| FaxNumber: | 2252501026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2022 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.