Individual
LARRY GENTRY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW/LCSW/LCAC
Contact information
Practice address
8320 MADISON AVE, INDIANAPOLIS, IN 46227-6066
(317) 882-5122
(317) 888-8642
Mailing address
8320 MADISON AVE, INDIANAPOLIS, IN 46227-6066
(317) 882-5122
(317) 888-8642
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001394A
IN
1041C0700X
Clinical Social Worker
Primary
34006901A
IN
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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