Provider Demographics
NPI:1861507048
Name:DEFRANCO, LORA RENEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:RENEE
Last Name:DEFRANCO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 253-AWA
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-0253
Mailing Address - Country:US
Mailing Address - Phone:262-422-4203
Mailing Address - Fax:855-631-0559
Practice Address - Street 1:722 MAIN ST. - ABSOLUTE WELLNESS ASSOCIATES, LLC
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:54178-1835
Practice Address - Country:US
Practice Address - Phone:262-422-4203
Practice Address - Fax:855-631-0559
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3018-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43575600Medicaid