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General NPI Number Information
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NPI Number | 1003797119
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE SOCIAL WORK SERVICES LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 9501 INDIANAPOLIS BLVD STE A
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City | HIGHLAND
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State | IN
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Zip | 46322-2665
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Country | US
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Telephone | 219-368-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 904 BECKER ST
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City | HAMMOND
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State | IN
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Zip | 46320-2109
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Country | US
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Telephone | 219-677-3169
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. TENISHA FENNIE
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Credential | LCSW
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Telephone | 219-677-3169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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