LEISA D. LUDLAM PH.D., P.A.
Social Work at University Pkwy, Pensacola, FL

License number
Florida PY0004705
Category
Social Work
Type
Clinical
Owner
Name: LEISA DIANNE LUDLAM PH.D.
Title: PRESIDENT
Phone: (850) 484-9026
Address
Address
9007 University Pkwy, Pensacola, FL 32514
National Provider ID: 1255367918
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LEISA D. LUDLAM, PH.D., PA

Milton, FL  -  Pensacola, FL

Registration:
Jul 5, 2002
Addresses:
4509 Woodbine Rd, Milton, FL 32571 (Physical)
9007 University Pkwy, Pensacola, FL 32514
State ID:
P02000074154
Business type:
Florida Profit Corporation
President, Director:
Leisa D Ludlam (President, Director), 4509 Woodbine Rd, Milton, FL 32571 (Physical)
Agent:
Leisa Ludlam,4509 Woodbine Rd, Milton, FL 32571 (Physical)
EIN:
611434566

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