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Organization
THE PILGRIMAGE CENTER, INC
Active
Organization
THE PILGRIMAGE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAX CHARLES BLANKENBURG MSSW/LCSW (EXECUTIVE DIRECTOR)
(317) 575-9855
Entity
Organization
Contact information
Practice address
10210 N MERIDIAN ST, INDIANAPOLIS, IN 46290-1022
(317) 575-9855
(317) 575-1709
Mailing address
10210 N MERIDIAN ST, INDIANAPOLIS, IN 46290-1022
(317) 575-9855
(317) 575-1709
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39001869A
IN
1041C0700X
Clinical Social Worker
Primary
34000813A
IN
106H00000X
Marriage & Family Therapist
35000794A
IN
Other
Enumeration date
09/24/2008
Last updated
09/24/2008
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