| Providence Counseling Center, Inc. | |
|
10305 Dawsons Creek Blvd Suite C Fort Wayne IN 46825-1914 | |
| (260) 418-6765 | |
| (260) 416-0601 |
| Full Name | Providence Counseling Center, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 10305 Dawsons Creek Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | C Laudia D Davis (PRESIDENT/CEO) |
| Authorized Official Contact | 2604186765 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Counseling Center, Inc. Po Box 5622 Fort Wayne IN 46895-5622 Ph: (260) 418-6765 | Providence Counseling Center, Inc. 10305 Dawsons Creek Blvd Suite C Fort Wayne IN 46825-1914 Ph: (260) 418-6765 |
| NPI Number | 1174619654 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174619654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34004602A (Indiana) | Primary |
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