Provider Demographics
NPI:1386831725
Name:LAFAYETTE, WILMA (LISW)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:LAFAYETTE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 NO FOUNTAIN BLVD
Mailing Address - Street 2:COMMUNITY MERCY REACH
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504
Mailing Address - Country:US
Mailing Address - Phone:937-390-5338
Mailing Address - Fax:937-342-4311
Practice Address - Street 1:1343 NO FOUNTAIN BLVD
Practice Address - Street 2:COMMUNITY MERCY REACH
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504
Practice Address - Country:US
Practice Address - Phone:937-390-5338
Practice Address - Fax:937-342-4311
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHI 0009294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)