Provider Demographics
NPI:1932922283
Name:ALFORD, TERESA LYNN (PPS)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYNN
Last Name:ALFORD
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:ALFORD-MAYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20848 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5423
Mailing Address - Country:US
Mailing Address - Phone:209-352-7497
Mailing Address - Fax:
Practice Address - Street 1:175 FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4809
Practice Address - Country:US
Practice Address - Phone:209-536-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220283751101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool