Individual
TIA WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4747 W 24TH AVE, GARY, IN 46406-2821
(219) 240-8615
Mailing address
4747 W 24TH AVE, GARY, IN 46406-2821
(219) 240-8615
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/04/2015
Last updated
09/04/2015
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