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General NPI Number Information
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NPI Number | 1922215193
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Entity Type | Organization
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Legal Business Name | AVON CHRISTIAN COUNSELING CENTER
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 79 N COUNTY ROAD 625 E
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City | AVON
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State | IN
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Zip | 46123-9724
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Country | US
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Telephone | 317-272-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 79 N COUNTY ROAD 625 E
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City | AVON
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State | IN
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Zip | 46123-9724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ABRAHAM ATHIALY
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Credential |
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Telephone | 317-272-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39000774A
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License Number State | IN
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