Provider Demographics
NPI:1922238500
Name:ALFORD, NEQUETTA LASHAWN (MBA/ABA)
Entity Type:Individual
Prefix:
First Name:NEQUETTA
Middle Name:LASHAWN
Last Name:ALFORD
Suffix:
Gender:F
Credentials:MBA/ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 REACH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1114
Mailing Address - Country:US
Mailing Address - Phone:215-416-8434
Mailing Address - Fax:
Practice Address - Street 1:5921 REACH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1114
Practice Address - Country:US
Practice Address - Phone:215-416-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst