Individual
JEANINE KING CHILDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD LMHC
Contact information
Practice address
4656 W JEFFERSON BLVD STE 285, FORT WAYNE, IN 46804-6838
(260) 422-9372
(260) 422-0843
Mailing address
4656 W JEFFERSON BLVD STE 285, FORT WAYNE, IN 46804-6838
(260) 422-9372
(260) 422-0843
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001262A
IN
Other
Enumeration date
04/09/2010
Last updated
02/19/2018
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