Individual
KIMTOIYA ONEAL SAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAC
Contact information
Practice address
3430 CORK BEND DR, INDIANAPOLIS, IN 46239-7669
(317) 966-7772
Mailing address
3430 CORK BEND DR, INDIANAPOLIS, IN 46239-7669
(317) 966-7772
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87000037A
IN
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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