Provider Demographics
NPI:1245351261
Name:LAFAYETTE, DANA (LPC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LAFAYETTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W WACO DR
Mailing Address - Street 2:STE B-2 #220
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7010
Mailing Address - Country:US
Mailing Address - Phone:254-214-4267
Mailing Address - Fax:
Practice Address - Street 1:4300 W WACO DR
Practice Address - Street 2:STE B-2 #220
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7010
Practice Address - Country:US
Practice Address - Phone:254-214-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66098101YM0800X
TX11318101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)