Most Relevant Information
Provider Data
| NPI Number: | 1003643115 |
| Provider Name: | CHRISTOPER MAURICE LYLE LADAC II |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 1628 |
Most Important Dates
| Enumeration Date: | 09/14/2024 |
| Last Updated: | 09/14/2024 |
Provider Practice Location
912 DALEMORE LN
CORDOVA
TN
380188238
Practice Location Phone/Fax
| Phone: | 9016538352 |
| Fax: |
Provider Mailing Location
912 DALEMORE LN
CORDOVA
TN
380188238
Provider Mailing Phone/Fax
| Phone: | 9016538352 |
| Fax: |