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General NPI Number Information
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NPI Number | 1861210247
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Entity Type | Organization
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Legal Business Name | INSTILLING HOPE ADDICTION THERAPY, LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1690 BROADWAY BLD 19 SUITE 10
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City | FORT WAYNE
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State | IN
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Zip | 46802-0010
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Country | US
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Telephone | 260-409-8432
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Fax |
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Provider Business Mailing Address
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Address Line | 1690 BROADWAY BLD 19 SUITE 10
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City | FORT WAYNE
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State | IN
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Zip | 46802-0010
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Country | US
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Telephone | 260-409-8432
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL ADDICTION THERAPIST
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Name | TERRELL JERMAINE BROWN
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Credential | BA, MS, MA, LCAC
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Telephone | 260-234-9009
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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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