| NPI | 1801487574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE JACKSON PITTMAN COO/ Psychotherapist 219-613-7872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 101YM0800X Counselor, Mental Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-01-11 |