Healthcare Provider Details

I. General information

NPI: 1811047608
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF FORT WAYNE-SOUTH BEND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 SOUTH CLINTON
FORT WAYNE IN
46802
US

IV. Provider business mailing address

PO BOX 10630
FORT WAYNE IN
46853-0630
US

V. Phone/Fax

Practice location:
  • Phone: 260-422-5625
  • Fax: 260-422-5657
Mailing address:
  • Phone: 260-422-5625
  • Fax: 260-422-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. GLORIA WHITCRAFT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.S. ED, LMFT
Phone: 260-422-5625