Provider Demographics
NPI:1679966519
Name:ALFORD-LAWSON, LOUVENIA (LPC)
Entity Type:Individual
Prefix:DR
First Name:LOUVENIA
Middle Name:
Last Name:ALFORD-LAWSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIVERSIFIED
Other - Middle Name:COUNSELING &
Other - Last Name:CONSULTING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:PINE LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 SCENIC HWY N
Practice Address - Street 2:SUITE 266
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7907
Practice Address - Country:US
Practice Address - Phone:404-500-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161345AMedicaid