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Organization
INTEGRATED MENTAL HEALTH AND ADDICTION TREATMENT SERVICES
Active
Organization
INTEGRATED MENTAL HEALTH AND ADDICTION TREATMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMTOIYA O SAM LCAC (OWNER)
(317) 966-7772
Entity
Organization
Contact information
Practice address
3430 CORK BEND DR, INDIANAPOLIS, IN 46239-7669
(317) 966-7772
Mailing address
3430 CORK BEND DR, INDIANAPOLIS, IN 46239-7669
(317) 966-7772
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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