Provider Demographics
NPI:1518796101
Name:LUDLOW, ADAM (CRISIS SPECIALIST)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:CRISIS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4144
Mailing Address - Country:US
Mailing Address - Phone:925-858-0412
Mailing Address - Fax:
Practice Address - Street 1:406 SUNRISE AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4144
Practice Address - Country:US
Practice Address - Phone:925-858-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker