Provider Demographics
NPI:1104411594
Name:DAFFRON, ADRIAN LYNN
Entity type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:LYNN
Last Name:DAFFRON
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 1:36 CARGOMASTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28307-1547
Mailing Address - Country:US
Mailing Address - Phone:812-821-7042
Mailing Address - Fax:
Practice Address - Street 1:36 CARGOMASTER ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307-1547
Practice Address - Country:US
Practice Address - Phone:812-821-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician