Healthcare Provider Details

I. General information

NPI: 1851219067
Provider Name (Legal Business Name): ADEEBA HUSSAIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 DELSEA DR S
GLASSBORO NJ
08028-2621
US

IV. Provider business mailing address

42 DELSEA DR S
GLASSBORO NJ
08028-2621
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-3632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00830800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: