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NPI Code Detail

MEDICARE: DR. DAE'QUAWN LANDRUM LPC, LCADC

MEDICARE: DR. DAE'QUAWN LANDRUM LPC, LCADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor37AC00490900NJ

General Provider Information

NPI Number : 1942828629
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAE'QUAWN LANDRUM LPC, LCADC
Provider Business Mailing Address
First Line : 78 JOHN MILLER WAY STE 326
Second Line :
City : KEARNY
State : NJ
Zip : 07032-6533
Country : US
Telephone Number : 908-864-6342
Fax Number :
Provider Business Practice Location Address
First Line : 78 JOHN MILLER WAY STE 326
Second Line :
City : KEARNY
State : NJ
Zip : 07032-6533
Country : US
Telephone Number : 908-864-6342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2020
Last Update Date : 02/07/2026

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