Healthcare Provider Details

I. General information

NPI: 1922059492
Provider Name (Legal Business Name): AVALON COUNSELING & CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W 4TH ST
MISHAWAKA IN
46544-1913
US

IV. Provider business mailing address

323 W 4TH ST
MISHAWAKA IN
46544-1913
US

V. Phone/Fax

Practice location:
  • Phone: 574-256-7006
  • Fax: 574-256-2266
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: TERESIA NEWTON
Title or Position: PARTNER
Credential: LCSW
Phone: 574-256-7006