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General NPI Number Information
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NPI Number | 1568834109
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Entity Type | Individual
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Provider Name | EVELYN GAITHER
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Gender | Female
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 9820 E 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46235-2303
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Country | US
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Telephone | 317-899-2010
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Fax | 317-898-0060
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Provider Business Mailing Address
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Address Line | 7330 DEERFIELD DR
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City | GREENFIELD
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State | IN
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Zip | 46140-9500
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Country | US
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Telephone | 317-899-2010
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Fax | 317-898-0060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 86000082A
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License Number State | IN
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