IVY PETRA

GOSHEN, IN
NPI1538592704
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: IN  34006676A)
Additional Taxonomies101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: IN  87001243A)
Enumeration Date2013-08-12
Last Update Date2020-12-31
Business Address
IVY PETRA LCSW, LCAC
213 MIDDLEBURY ST
GOSHEN, IN 46528
Phone number: 574-534-3300
Mailing Address
IVY PETRA LCSW, LCAC
213 MIDDLEBURY ST
GOSHEN, IN 46528-2956
Phone number: 574-534-3300