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Organization
LAKE SUBSTANCE ABUSE SOLUTIONS LLC
Active
Organization
LAKE SUBSTANCE ABUSE SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CORDDRY (OWNER)
(407) 622-8086
Entity
Organization
Contact information
Practice address
1507 SPRING ST, JEFFERSONVILLE, IN 47130-2939
(833) 525-3727
Mailing address
225 W CANTON AVE STE 600, WINTER PARK, FL 32789-3181
(407) 622-8086
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/27/2018
Last updated
09/02/2025
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