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Organization
SELF-EXPRESSION TEEN THEATER
Active
Organization
SELF-EXPRESSION TEEN THEATER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES MUHAMMAD MA, CHES, CTCC, OCPS (EXECUTIVE DIRECTOR)
(419) 242-2255
Entity
Organization
Contact information
Practice address
1001 INDIANA AVE, SUITE 203-204, TOLEDO, OH 43607-4084
(419) 242-2255
(419) 242-3152
Mailing address
1001 INDIANA AVE, SUITE 203-204, TOLEDO, OH 43607-4084
(419) 242-2255
(419) 242-3152
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
NULL
Other
Enumeration date
10/05/2006
Last updated
08/22/2020
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