| NPI | 1770027351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAVONDA JACKSON Executive Director 219-670-0311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001377A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IN 39001377A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 39001377A) | |
| 101Y00000X Counselor (Licence: IN 39001377A) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 39001377A) | |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2016-12-15 |