Basic Information
| Provider Information | |||||||||
| NPI: | 1780052928 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABC COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6526 HILLSBORO LN | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468351821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604942205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6526 HILLSBORO LN | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468351821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604942205 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | OSBORN | ||||||||
| AuthorizedOfficialFirstName: | ALIA | ||||||||
| AuthorizedOfficialMiddleName: | DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2604942205 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 33006408A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.