Healthcare Provider Details

I. General information

NPI: 1700618923
Provider Name (Legal Business Name): ANGELA CUPNII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 E 82ND ST
INDIANAPOLIS IN
46256-1465
US

IV. Provider business mailing address

9295 W QUARTER MOON DR
PENDLETON IN
46064-8667
US

V. Phone/Fax

Practice location:
  • Phone: 812-200-2789
  • Fax:
Mailing address:
  • Phone: 574-238-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87900134A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: