Organization
UJIMA THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. OLINKA LASHAE CLARK MSW (EXECUTIVE DIRECTOR)
(260) 418-6080
Entity
Organization
Contact information
Practice address
2250 LAKE AVE STE 270, FORT WAYNE, IN 46805-5352
(260) 418-6080
Mailing address
2250 LAKE AVE STE 270, FORT WAYNE, IN 46805-5352
(260) 418-6080
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/14/2021
Last updated
02/15/2021
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