Healthcare Provider Details

I. General information

NPI: 1427993054
Provider Name (Legal Business Name): JEANINE WILLIAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8448 E 100 N
LAFAYETTE IN
47905-8741
US

IV. Provider business mailing address

8448 E 100 N
LAFAYETTE IN
47905-8741
US

V. Phone/Fax

Practice location:
  • Phone: 765-491-1952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEANINE WILLIAMS
Title or Position: OWNER
Credential:
Phone: 765-491-1952