Provider Demographics
NPI:1568235166
Name:FLUDD, DELANTE
Entity Type:Individual
Prefix:
First Name:DELANTE
Middle Name:
Last Name:FLUDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 STAPLES ST NE APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2954
Mailing Address - Country:US
Mailing Address - Phone:202-763-2825
Mailing Address - Fax:
Practice Address - Street 1:1255 UNION ST NE FL 7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7042
Practice Address - Country:US
Practice Address - Phone:903-217-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001628101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor