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General NPI Number Information
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NPI Number | 1588419253
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Entity Type | Organization
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Legal Business Name | SELF CARE COUNSELING, LLC
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 535 AIRPORT NORTH OFFICE PARK
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City | FORT WAYNE
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State | IN
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Zip | 46825-6705
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Country | US
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Telephone | 260-619-1603
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Fax | 260-818-2121
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Provider Business Mailing Address
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Address Line | 535 AIRPORT NORTH OFFICE PARK
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City | FORT WAYNE
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State | IN
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Zip | 46825-6705
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Country | US
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Telephone | 260-619-1603
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Fax | 260-818-2121
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Authorized Official
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Title or Position | LICENSED THERAPIST/OWNER
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Name | SEPHORA LORTIE
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Credential | LMHC, LAC, MA
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Telephone | 260-619-1603
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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 |
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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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