Provider Demographics
NPI:1477841450
Name:LAFAYETTE, LASHONDA
Entity Type:Individual
Prefix:
First Name:LASHONDA
Middle Name:
Last Name:LAFAYETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-4002
Mailing Address - Country:US
Mailing Address - Phone:870-703-9546
Mailing Address - Fax:870-703-9546
Practice Address - Street 1:11 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-4002
Practice Address - Country:US
Practice Address - Phone:870-703-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ARP1311109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor