Provider Demographics
NPI:1114689445
Name:COLON-PABON, LUDGERIA JENNISE (LPC)
Entity Type:Individual
Prefix:
First Name:LUDGERIA
Middle Name:JENNISE
Last Name:COLON-PABON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 KIRKLAND ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-3135
Mailing Address - Country:US
Mailing Address - Phone:787-390-7951
Mailing Address - Fax:
Practice Address - Street 1:7041 GRAND NATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8381
Practice Address - Country:US
Practice Address - Phone:407-982-7718
Practice Address - Fax:407-704-5953
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2629101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor