Organization
MARILLAC COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY MASSONNE LCSW (OWNER)
(260) 222-6367
Entity
Organization
Contact information
Practice address
4630 W JEFFERSON BLVD STE 3, FORT WAYNE, IN 46804-6800
(260) 222-6367
(260) 235-5328
Mailing address
5112 INDIANA AVE, FORT WAYNE, IN 46807-3026
(260) 222-6367
(260) 235-5328
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/17/2021
Last updated
05/18/2021
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