Provider Demographics
NPI:1841605193
Name:LOFTON, LAWANA (PSYD)
Entity Type:Individual
Prefix:
First Name:LAWANA
Middle Name:
Last Name:LOFTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 VALLE VISTA DRIVE
Mailing Address - Street 2:UNIT 6310
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590
Mailing Address - Country:US
Mailing Address - Phone:415-577-8716
Mailing Address - Fax:
Practice Address - Street 1:88 VALLE VISTA DRIVE
Practice Address - Street 2:UNIT 6310
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590
Practice Address - Country:US
Practice Address - Phone:415-577-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical