Healthcare Provider Details

I. General information

NPI: 1912831983
Provider Name (Legal Business Name): LAURIANE FLORE DACKO BUGUEU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2386 LOCUST ST S
CANAL FULTON OH
44614-9390
US

IV. Provider business mailing address

2386 LOCUST ST S
CANAL FULTON OH
44614-9390
US

V. Phone/Fax

Practice location:
  • Phone: 234-529-7126
  • Fax: 234-529-7126
Mailing address:
  • Phone: 234-529-7126
  • Fax: 234-529-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: