Healthcare Provider Details

I. General information

NPI: 1760963482
Provider Name (Legal Business Name): ESTHER NATACHA LAFONTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 MAPLE TERRACE DRIVE
SUWANEE GA
30024
US

IV. Provider business mailing address

3205 MAPLE TERRACE DRIVE
SUWANEE GA
30024
US

V. Phone/Fax

Practice location:
  • Phone: 808-358-6740
  • Fax:
Mailing address:
  • Phone: 808-358-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: