Provider Demographics
NPI:1316777881
Name:LAFORM, JANELL (RADT)
Entity type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:
Last Name:LAFORM
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 GRIFFEY WAY
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-3065
Mailing Address - Country:US
Mailing Address - Phone:916-612-2452
Mailing Address - Fax:209-744-9910
Practice Address - Street 1:750 SPAANS DR STE CDANDF
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8609
Practice Address - Country:US
Practice Address - Phone:209-744-9099
Practice Address - Fax:209-744-9910
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1573210824101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)