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General NPI Number Information
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NPI Number | 1710768809
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Entity Type | Individual
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Provider Name | WILLIAM BENJAMIN COPELAND LADAC II
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Gender | Male
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 1169 NASHVILLE HWY
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City | LEWISBURG
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State | TN
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Zip | 37091-2236
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Country | US
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Telephone | 865-378-6929
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Fax |
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Provider Business Mailing Address
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Address Line | 700 4TH ST SW
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City | CHILDERSBURG
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State | AL
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Zip | 35044-1620
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Country | US
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Telephone | 615-924-0274
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LDC0000001220
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License Number State | TN
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