Provider Demographics
NPI:1073079679
Name:BALAJADIA, GENEVIEVE A (MA, T-CADC)
Entity type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:A
Last Name:BALAJADIA
Suffix:
Gender:F
Credentials:MA, T-CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:799 MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6825
Mailing Address - Country:US
Mailing Address - Phone:563-582-3784
Mailing Address - Fax:563-582-4006
Practice Address - Street 1:799 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6825
Practice Address - Country:US
Practice Address - Phone:563-582-3784
Practice Address - Fax:563-582-4006
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT18043101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2580Medicaid