Provider Information for 1235553256
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TERRA LADAUN PRINCE-ENGRAM LCSW, CAP, ICADC
Other Names:Professional Name:TERRA LADAUN PRINCE LCSWSex: Female
NPI: 1235553256
Last Updated: 2014-06-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1235553256 | ||||||||||||
| Enumeration Date | 2014-02-11 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1492 W FLAGLER ST MIAMI, FL 33135-2209 United States Phone: 786-365-6659 | Fax: | ||||||||||||
| Primary Practice Address | 1492 W FLAGLER ST MIAMI, FL 33135-2209 United States Phone: 786-365-6659 | Fax: | ||||||||||||
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