Organization
LIVING WELLNESS RESPITE RETREAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAKENYA SHAE PATTERSON (CO-OWNER)
(317) 414-6294
Entity
Organization
Contact information
Practice address
1531 WELLINGTON AVE, INDIANAPOLIS, IN 46219-3844
(317) 628-0381
Mailing address
1531 WELLINGTON AVE, INDIANAPOLIS, IN 46219-3844
(317) 628-0381
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
385HR2055X
Child Mental Illness Respite Care
Primary
—
—
Other
Enumeration date
11/04/2022
Last updated
11/04/2022
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