Provider Demographics
NPI:1043771132
Name:HEARD, LA'FONDA NICOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:LA'FONDA
Middle Name:NICOLE
Last Name:HEARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LA'FONDA
Other - Middle Name:NICOLE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:9151 INTERLINE AVE STE 9A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1970
Mailing Address - Country:US
Mailing Address - Phone:225-907-1698
Mailing Address - Fax:225-416-6164
Practice Address - Street 1:9151 INTERLINE AVE STE 9A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1970
Practice Address - Country:US
Practice Address - Phone:225-907-1698
Practice Address - Fax:225-416-6164
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YP1600X
LALH322367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALH322367OtherLICENSED PROFESSIONAL CHRISTIAN THERAPIST