Healthcare Provider Details

I. General information

NPI: 1184707556
Provider Name (Legal Business Name): VIETNAM VETERANS FAMILY ASSISTANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 W CENTENNIAL AVE
MUNCIE IN
47303-2974
US

IV. Provider business mailing address

723 W CENTENNIAL AVE
MUNCIE IN
47303-2974
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-4015
  • Fax: 765-288-4047
Mailing address:
  • Phone: 765-288-4015
  • Fax: 765-288-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LISA A LOHREY
Title or Position: BILLING SPECIALIST
Credential:
Phone: 765-620-8529