Provider Demographics
NPI:1659773737
Name:LIVINGSTON, ALFRED (CAADC)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-3352
Mailing Address - Country:US
Mailing Address - Phone:229-426-0002
Mailing Address - Fax:229-426-0008
Practice Address - Street 1:410 S SHERMAN ST
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-3352
Practice Address - Country:US
Practice Address - Phone:229-426-0002
Practice Address - Fax:229-426-0008
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC0124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)