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General NPI Number Information
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NPI Number | 1437463379
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Entity Type | Individual
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Provider Name | LANNY WAYNE LEDFORD MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 743 MAIN ST SW
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City | GAINESVILLE
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State | GA
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Zip | 30501-4484
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Country | US
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Telephone | 678-943-2749
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Fax | 678-943-2746
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Provider Business Mailing Address
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Address Line | 303 GREEN ST NW
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City | GAINESVILLE
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State | GA
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Zip | 30501-3327
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Country | US
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Telephone | 678-343-1451
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Fax | 678-943-2746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CSW004082
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License Number State | GA
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