Individual
LEISA DIANNE LUDLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
4509 WOODBINE RD, PACE, FL 32571-8706
(850) 995-2500
(850) 995-2501
Mailing address
4509 WOODBINE RD, PACE, FL 32571-8706
(850) 995-2500
(850) 995-2501
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY0004705
FL
Other
Enumeration date
06/25/2006
Last updated
06/05/2008
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