Organization
CHILD THERAPY LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RONIQUA TESHAE ZIMMERMANN LCSW (OWNER/DIRECTOR)
(317) 662-4403
Entity
Organization
Contact information
Practice address
53174 FLOWING STREAM CT, SOUTH BEND, IN 46628-9034
(317) 662-4403
(317) 900-1896
Mailing address
53174 FLOWING STREAM CT, SOUTH BEND, IN 46628-9034
(317) 662-4403
(317) 900-1896
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/06/2021
Last updated
08/06/2021
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