Basic Information
Provider Information
NPI: 1235780610
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALFORD
FirstName: EMILY
MiddleName: KATHERINE
NamePrefix:  
NameSuffix:  
Credential: LPCA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 LAUGHING OAK LN
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284016199
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 120 COASTAL HORIZONS DR
Address2:  
City: SHALLOTTE
State: NC
PostalCode: 284706094
CountryCode: US
TelephoneNumber: 9107544515
FaxNumber: 9102029966
Other Information
ProviderEnumerationDate: 09/26/2019
LastUpdateDate: 12/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/10/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XA14388NCN Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500XA14388NCY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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