Provider Demographics
NPI:1942828629
Name:LANDRUM, DAE'QUAWN (LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:DAE'QUAWN
Middle Name:
Last Name:LANDRUM
Suffix:
Gender:M
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WISTERIA DR APT 1L
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1114
Mailing Address - Country:US
Mailing Address - Phone:443-983-3059
Mailing Address - Fax:
Practice Address - Street 1:12 WISTERIA DR APT 1L
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1114
Practice Address - Country:US
Practice Address - Phone:443-983-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00490900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health