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ELAINE GRANT LADAC
Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1538554332
Individual Registrant: ELAINE GRANT LADAC
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
152 S HAMLETSBURG RD BROOKPORT, IL 62910-2961 US
Tel: 615-967-8978 Fax: --
Tel: 615-967-8978 Fax: --
Contact information for business:
152 S HAMLETSBURG RD BROOKPORT, IL 62910-2961 US
Tel: 615-967-8978 Fax: --
Tel: 615-967-8978 Fax: --
Registration Information:
NPI: 1538554332
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YA0400X | Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder) | TN | LADAC |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
