Healthcare Provider Details

I. General information

NPI: 1760951925
Provider Name (Legal Business Name): JAMES ANDREW COOPER LADAC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2018
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 GRAND RIVER AVE
DETROIT MI
48204-2139
US

IV. Provider business mailing address

21815 HIDDEN RIVERS DR N
SOUTHFIELD MI
48075-1035
US

V. Phone/Fax

Practice location:
  • Phone: 313-834-5930
  • Fax:
Mailing address:
  • Phone: 505-221-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0198711
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2-01767
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: