Provider Demographics
NPI:1710631452
Name:BEAUFORD, LADONNA RACHEL
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:RACHEL
Last Name:BEAUFORD
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 1:107 SOUTHERN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7591
Mailing Address - Country:US
Mailing Address - Phone:850-602-6403
Mailing Address - Fax:850-435-4134
Practice Address - Street 1:107 SOUTHERN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7591
Practice Address - Country:US
Practice Address - Phone:850-602-6403
Practice Address - Fax:850-435-4134
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services