Healthcare Provider Details

I. General information

NPI: 1023021987
Provider Name (Legal Business Name): AFTON LAVALLEE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 ANCHOR ON LANIER CT
GAINESVILLE GA
30506-6785
US

IV. Provider business mailing address

8615 ANCHOR ON LANIER CT
GAINESVILLE GA
30506-6785
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-9100
  • Fax: 770-534-9104
Mailing address:
  • Phone: 770-534-9100
  • Fax: 770-534-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY001728
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: