Provider Demographics
NPI:1205412236
Name:ALDAG, DESIREE (BS, CAP, CBHCM)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ALDAG
Suffix:
Gender:F
Credentials:BS, CAP, CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 DELANO CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3015
Mailing Address - Country:US
Mailing Address - Phone:407-508-4512
Mailing Address - Fax:
Practice Address - Street 1:3218 E COLONIAL DR STE G
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5125
Practice Address - Country:US
Practice Address - Phone:407-508-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM101864171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator