Healthcare Provider Details

I. General information

NPI: 1942786009
Provider Name (Legal Business Name): INDIA CRAFT LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 E WOODRUFF AVE
TOLEDO OH
43604-5342
US

IV. Provider business mailing address

7220 NIGHTINGALE DR APT 11
HOLLAND OH
43528-9302
US

V. Phone/Fax

Practice location:
  • Phone: 419-936-7548
  • Fax:
Mailing address:
  • Phone: 419-322-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number162905
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: