MEDICARE: JANICE CHURCH LADAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	TN-033	TN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCD0000001471	TN

General Provider Information

NPI Number	:	1598338196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE CHURCH LADAC

Provider Business Mailing Address
First Line	:	139 WH RUSSELL LN
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-5234
Country	:	US
Telephone Number	:	937-416-2794
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 WH RUSSELL LN
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-5234
Country	:	US
Telephone Number	:	937-416-2794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	01/25/2026

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Directions to “ JANICE CHURCH LADAC” Practice Location

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