Organization
TRINITY FAITH-BASED UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARCELMARIE SMITH MS,CADC, MISA (PRESIDENT)
(219) 882-4010
Entity
Organization
Contact information
Practice address
839 BROADWAY, SUITE 104, GARY, IN 46402-2414
(219) 882-4010
(219) 882-0210
Mailing address
839 BROADWAY, SUITE 104, GARY, IN 46402-2414
(219) 882-4010
(219) 882-0210
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
20041768A
IN
Other
Enumeration date
07/24/2014
Last updated
07/24/2014
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