Provider Demographics
NPI:1235553256
Name:PRINCE-ENGRAM, TERRA LADAUN (LCSW, CAP, ICADC)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:LADAUN
Last Name:PRINCE-ENGRAM
Suffix:
Gender:F
Credentials:LCSW, CAP, ICADC
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:LADAUN
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1492 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2209
Mailing Address - Country:US
Mailing Address - Phone:786-365-6659
Mailing Address - Fax:
Practice Address - Street 1:1492 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2209
Practice Address - Country:US
Practice Address - Phone:786-365-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLSW119991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker