Individual
GWENDOLYN LAVORN HORTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, LCAC
Contact information
Practice address
24 JOLIET ST, DYER, IN 46311-1705
(219) 865-2141
(219) 864-2147
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87000621A
IN
Other
Enumeration date
12/12/2012
Last updated
03/13/2021
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