Provider Demographics
NPI:1548881022
Name:AFOLAYAN, AUDRETTE ALEXANDER
Entity type:Individual
Prefix:
First Name:AUDRETTE
Middle Name:ALEXANDER
Last Name:AFOLAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 RIVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1277
Mailing Address - Country:US
Mailing Address - Phone:954-394-6703
Mailing Address - Fax:
Practice Address - Street 1:321 RIVERVIEW CT
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1277
Practice Address - Country:US
Practice Address - Phone:954-394-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health