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General NPI Number Information
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NPI Number | 1184612137
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Entity Type | Organization
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Legal Business Name | FAMILY & CHILDREN'S CENTER OF COUNSELING AND DEVELOPMENT SERVICES INC
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 611 LINCOLNWAY EAST
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City | SOUTH BEND
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State | IN
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Zip | 46601-3220
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Country | US
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Telephone | 574-232-2255
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Fax | 574-232-8968
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Provider Business Mailing Address
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Address Line | 611 LINCOLNWAY EAST
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City | SOUTH BEND
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State | IN
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Zip | 46601-3220
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Country | US
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Telephone | 574-232-2255
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Fax | 574-232-8968
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. PATRICIA HANCOCK
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Credential | LCSW
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Telephone | 574-232-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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