Individual
VICTORIA CHARLESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAC
Contact information
Practice address
1110 W 5TH AVE, GARY, IN 46402-1723
(219) 885-4264
(219) 239-2944
Mailing address
5077 ADAMS ST, GARY, IN 46408-4628
(219) 887-0510
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001015A
IN
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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