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General NPI Number Information
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NPI Number | 1568235166
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Entity Type | Individual
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Provider Name | DELANTE FLUDD
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Gender | Male
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 1255 UNION ST NE FL 7
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City | WASHINGTON
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State | DC
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Zip | 20002-7042
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Country | US
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Telephone | 903-217-6359
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 STAPLES ST NE APT 4
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City | WASHINGTON
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State | DC
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Zip | 20002-2954
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Country | US
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Telephone | 202-763-2825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LGPC200001628
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License Number State | DC
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