Healthcare Provider Details

I. General information

NPI: 1316160096
Provider Name (Legal Business Name): JAMES W WARD M.S. CADACII LCAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W INDIANA ST
EVANSVILLE IN
47712-5637
US

IV. Provider business mailing address

517 E BUENA VISTA RD
EVANSVILLE IN
47711-2721
US

V. Phone/Fax

Practice location:
  • Phone: 812-205-5999
  • Fax: 317-257-1226
Mailing address:
  • Phone: 812-205-5999
  • Fax: 317-257-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1228-0-ASR
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: