| NPI | 1528602257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIAKA JACKSON Manager 317-835-3435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2023-04-26 |