Provider Demographics
NPI:1306073929
Name:NEQUETTA LASHAUN ALFORD
Entity type:Organization
Organization Name:NEQUETTA LASHAUN ALFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SPECIALIST CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:NEQUETTA
Authorized Official - Middle Name:LASHAUN
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA / ABA
Authorized Official - Phone:215-416-8434
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 1:1235 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5945
Practice Address - Country:US
Practice Address - Phone:215-416-8434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA131451801251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131451801Medicaid