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General NPI Number Information
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NPI Number | 1306073929
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Entity Type | Organization
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Legal Business Name | NEQUETTA LASHAUN ALFORD
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 1235 PINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5945
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Country | US
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Telephone | 215-416-8434
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Fax |
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Provider Business Mailing Address
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Address Line | 5921 REACH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120-1114
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Country | US
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Telephone | 215-416-8434
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR SPECIALIST CONSULTANT
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Name | MS. NEQUETTA LASHAUN ALFORD
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Credential | M.B.A. / ABA
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Telephone | 215-416-8434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 131451801
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License Number State | PA
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