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General NPI Number Information
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NPI Number | 1952790354
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Entity Type | Organization
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Legal Business Name | PEACE A FAITH-BASED SUBSTANCE ABUSE PROGRAM
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 5401 S EAST ST SUITE 205-C
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-2064
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Country | US
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Telephone | 317-412-9737
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Fax | 317-489-6089
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Provider Business Mailing Address
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Address Line | 5401 S EAST ST SUITE 205-C
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-2064
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Country | US
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Telephone | 317-412-9737
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Fax | 317-489-6089
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/OWNER
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Name | MRS. ROBIN DENISE CRUZ
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Credential | MSW, LCAC
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Telephone | 317-412-9737
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000715A
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License Number State | IN
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