Provider Demographics
NPI:1578342457
Name:HARRIS LAFOND, CIAGIL
Entity Type:Individual
Prefix:
First Name:CIAGIL
Middle Name:
Last Name:HARRIS LAFOND
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 1:4522 WASHINGTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1828
Mailing Address - Country:US
Mailing Address - Phone:304-982-3460
Mailing Address - Fax:
Practice Address - Street 1:4522 WASHINGTON AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1828
Practice Address - Country:US
Practice Address - Phone:304-982-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker