Individual
AMI DANIELLE FAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3220 E JEFFERSON BLVD, SOUTH BEND, IN 46615-3028
(574) 222-2466
Mailing address
2729 ROCKNE DR, SOUTH BEND, IN 46615-3436
(248) 703-6016
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39005230A
IN
221700000X
Art Therapist
—
—
Other
Enumeration date
01/28/2018
Last updated
12/04/2024
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