Individual
MR. MARK DAVID LAFOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2109 FAIRBURN RD, DOUGLASVILLE, GA 30135-1037
(770) 726-7958
Mailing address
2109 FAIRBURN RD, DOUGLASVILLE, GA 30135-1037
(770) 726-7958
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054516517
DRIVERS LICENSE
GA
Enumeration date
11/25/2019
Last updated
11/25/2019
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