Provider Demographics
NPI:1629817838
Name:ALFORD, TRACI MICHELLE
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:MICHELLE
Last Name:ALFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:MICHELLE
Other - Last Name:PARTRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:595 POSEY RD
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6805
Mailing Address - Country:US
Mailing Address - Phone:318-527-0611
Mailing Address - Fax:
Practice Address - Street 1:430 DIXIE PLZ
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5881
Practice Address - Country:US
Practice Address - Phone:318-357-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LAPLC10222101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator