Provider Demographics
NPI:1184028920
Name:ALFORD, CORINTHIA LILLIE (BA)
Entity Type:Individual
Prefix:MISS
First Name:CORINTHIA
Middle Name:LILLIE
Last Name:ALFORD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1320
Mailing Address - Country:US
Mailing Address - Phone:678-661-9483
Mailing Address - Fax:
Practice Address - Street 1:3214 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1320
Practice Address - Country:US
Practice Address - Phone:678-661-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities