Provider Demographics
NPI:1821848037
Name:LADELL, ANNETTE LYNNE (LLC, LSC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LYNNE
Last Name:LADELL
Suffix:
Gender:F
Credentials:LLC, LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SABER WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3372
Mailing Address - Country:US
Mailing Address - Phone:734-255-1109
Mailing Address - Fax:
Practice Address - Street 1:550 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2645
Practice Address - Country:US
Practice Address - Phone:810-660-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional