Provider Demographics
NPI:1114365095
Name:ALDAVA, ADELITA (LMSW)
Entity Type:Individual
Prefix:
First Name:ADELITA
Middle Name:
Last Name:ALDAVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 N TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2413
Mailing Address - Country:US
Mailing Address - Phone:316-263-6941
Mailing Address - Fax:316-263-5259
Practice Address - Street 1:437 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2413
Practice Address - Country:US
Practice Address - Phone:316-263-6941
Practice Address - Fax:316-263-5259
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8810101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker