Organization
SYDE BY SYDE CHANGES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ACQUINNETTA DOUGHTY LCAC (CEO)
(219) 333-7619
Entity
Organization
Contact information
Practice address
490 W 23RD AVE, GARY, IN 46407-3017
(219) 333-7619
Mailing address
490 W 23RD AVE, GARY, IN 46407-3017
(219) 333-7619
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/18/2021
Last updated
06/04/2024
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