Healthcare Provider Details

I. General information

NPI: 1851851760
Provider Name (Legal Business Name): ALEXANDREA CHRISTINE KARNICK I MS, LCACA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY
CHESTERTON IN
46304-2230
US

IV. Provider business mailing address

PO BOX 1430
PORTAGE IN
46368-9230
US

V. Phone/Fax

Practice location:
  • Phone: 219-763-8112
  • Fax: 219-763-8937
Mailing address:
  • Phone: 219-763-8112
  • Fax: 219-764-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87900013A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: