Individual
STEVEN M HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M,A,T,S, , CADAC II
Contact information
Practice address
8000 MELTON RD, GARY, IN 46403-3114
(219) 938-4651
(219) 938-4679
Mailing address
8000 MELTON RD, GARY, IN 46403-3114
(219) 938-4651
(219) 938-4679
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CII-2100
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18414112996
—
IN
Enumeration date
08/16/2019
Last updated
08/16/2019
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