180 Enterprise
Counselor, Addiction (Substance Use Disorder) in Indianapolis, IN. Organization (NPI-2).
NPI number1619564549
StatusActive
Last updated in NPPESDec 27, 2020
Details
- NPI
- 1619564549
- Entity type
- Organization (NPI-2)
- Legal business name
- 180 Enterprise
- Organization subpart
- No
- Enumeration date
- Dec 27, 2020
- Certification date
- Dec 27, 2020
- Last updated
- Dec 27, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | Yes |
Practice location
3430 Cork Bend DrIndianapolis, IN 46239-7669
Phone 317-966-7772
Mailing address
3430 Cork Bend DrIndianapolis, IN 46239-7669
Phone 317-966-7772
Authorized official
Kimtoiya Sam
Owner
3179667772
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