Individual
MRS. DEMETRIA A MACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADAC II; LAC
Contact information
Practice address
1100 W. 6TH AVE, GARY, IN 46402
(219) 885-4264
(219) 239-2944
Mailing address
1514 GLENWOOD AVE., GRIFFITH, IN 46319
(219) 588-9223
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
86000292A
IN
Other
Enumeration date
07/18/2014
Last updated
07/18/2014
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