Healthcare Provider Details

I. General information

NPI: 1942561162
Provider Name (Legal Business Name): CAPITOL CITY FAMILY AND EDUCATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6049 BROADWAY
MERRILLVILLE IN
46410-2619
US

IV. Provider business mailing address

6049 BROADWAY
MERRILLVILLE IN
46410-2619
US

V. Phone/Fax

Practice location:
  • Phone: 219-331-4794
  • Fax: 219-756-1503
Mailing address:
  • Phone: 219-331-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: PRISCILLA SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 219-331-4794