Provider Demographics
NPI:1306548870
Name:LAFORGE, ALEX GAVIN (RBT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:GAVIN
Last Name:LAFORGE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 LEGACY POINTE WAY APT 531
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-2177
Mailing Address - Country:US
Mailing Address - Phone:865-898-6445
Mailing Address - Fax:
Practice Address - Street 1:3000 LEGACY POINTE WAY APT 531
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-2177
Practice Address - Country:US
Practice Address - Phone:865-898-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician