Provider Demographics
NPI:1750643672
Name:LOFTON, TRICIA BACON
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:BACON
Last Name:LOFTON
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 1:2104 LOOP ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINNNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295
Mailing Address - Country:US
Mailing Address - Phone:318-435-6377
Mailing Address - Fax:318-435-6378
Practice Address - Street 1:2104 LOOP ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:WINNNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295
Practice Address - Country:US
Practice Address - Phone:318-435-6377
Practice Address - Fax:318-435-6378
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA72951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical