Organization
LAKESIDE BEHAVIORAL SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLEOTIS WHITE LCSW//LCAC (CEO)
(219) 801-1789
Entity
Organization
Contact information
Practice address
5944 1/2 HOHMAN AVE, HAMMOND, IN 46320-2424
(219) 801-1789
(219) 354-0356
Mailing address
1804EAST 142STREET, EAST CHICAGO, IN 46312-3010
(219) 801-1789
(219) 354-0356
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636-0-ASO
FAMILY AND SOCIAL SERVICES ADMINISTRATION
IN
Enumeration date
02/08/2012
Last updated
02/08/2012
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