Individual
DESIRAE DENIECE DRALUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, MS
Contact information
Practice address
727 W 2ND ST, BLOOMINGTON, IN 47403-2209
(812) 353-3450
(812) 353-3451
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
39003893A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300070376
—
IN
Enumeration date
07/12/2016
Last updated
02/15/2024
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