Healthcare Provider Details

I. General information

NPI: 1801948062
Provider Name (Legal Business Name): ASSOCIATES IN COUNSELING AND PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 CHARLESTOWN RD
NEW ALBANY IN
47150-2536
US

IV. Provider business mailing address

2627 CHARLESTOWN RD
NEW ALBANY IN
47150-2536
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-1550
  • Fax: 812-725-7865
Mailing address:
  • Phone: 812-944-1550
  • Fax: 812-725-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041227A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005077A
License Number StateIN

VIII. Authorized Official

Name: MS. LINDA S BURKE
Title or Position: OWNER/CLINICAL SUPV
Credential: LMHC
Phone: 812-944-1550