MEDICARE: DR. YALANDA LAVETTE GOLPHIN LCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1962836486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YALANDA LAVETTE GOLPHIN LCC

Provider Business Mailing Address
First Line	:	2745 FERN VALLEY DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6619
Country	:	US
Telephone Number	:	678-984-6194
Fax Number	:

Provider Business Practice Location Address
First Line	:	2745 FERN VALLEY DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6619
Country	:	US
Telephone Number	:	678-984-6194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	09/03/2013

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