Provider Demographics
NPI:1437463379
Name:LEDFORD, LANNY WAYNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LANNY
Middle Name:WAYNE
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 GREEN ST NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3327
Mailing Address - Country:US
Mailing Address - Phone:678-343-1451
Mailing Address - Fax:678-943-2746
Practice Address - Street 1:743 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4484
Practice Address - Country:US
Practice Address - Phone:678-943-2749
Practice Address - Fax:678-943-2746
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004082101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor