Provider Demographics
NPI:1992563555
Name:TU ALSTON, LAKREDI VINDA (BT)
Entity type:Individual
Prefix:
First Name:LAKREDI
Middle Name:VINDA
Last Name:TU ALSTON
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:LAKREDI
Other - Middle Name:V
Other - Last Name:TU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BT
Mailing Address - Street 1:1215 NOTTLEY DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7080
Mailing Address - Country:US
Mailing Address - Phone:147-062-0152
Mailing Address - Fax:
Practice Address - Street 1:1215 NOTTLEY DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-7080
Practice Address - Country:US
Practice Address - Phone:470-620-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician