| NPI | 1225404544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY A BANNISTER Owner/President 317-670-9413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34004283A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001400A) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2016-07-22 |