Individual
PATRICK J CHESEBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAC
Contact information
Practice address
4618 E STATE BLVD STE 300, FORT WAYNE, IN 46815-6966
(260) 373-0213
(260) 373-0218
Mailing address
4618 E STATE BLVD STE 300, FORT WAYNE, IN 46815-6966
(260) 373-0213
(260) 373-0218
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001654A
IN
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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