Individual
MS. NICAELI GRACE THEOBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5638 PROFESSIONAL CIR, INDIANAPOLIS, IN 46241-5042
(888) 714-1927
Mailing address
5241 W 15TH ST, INDIANAPOLIS, IN 46224-6415
(317) 987-4018
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/23/2022
Last updated
03/24/2025
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