Individual
ESTHER NATACHA LAFONTANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3205 MAPLE TERRACE DRIVE, SUWANEE, GA 30024
(808) 358-6740
Mailing address
3205 MAPLE TERRACE DRIVE, SUWANEE, GA 30024
(808) 358-6740
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
GA
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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