Provider Demographics
NPI:1053748293
Name:LADELE HEALTH
Entity type:Organization
Organization Name:LADELE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:DAHOMEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABANISHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-320-3233
Mailing Address - Street 1:1982 STATE ROAD 44 NUM 162
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168
Mailing Address - Country:US
Mailing Address - Phone:386-320-3233
Mailing Address - Fax:
Practice Address - Street 1:1982 STATE ROAD 44
Practice Address - Street 2:SUITE 162
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8349
Practice Address - Country:US
Practice Address - Phone:386-320-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8868103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty