| NPI | 1801487574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE JACKSON COO/ Psychotherapist 219-613-7872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2026-02-25 |