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Addiction Substance Use Disorder

Kokomo, Indiana

Provider NPI: 1619927589

Organization Information:
Organization is not Subpart
Authorized Official:  DONALD W. RIDENOUR  EXECUTIVE DIRECTOR  765-4579313

Practice Location:
618 S MAIN ST  KOKOMO, IN 46901 US
Tel: 765-457-9313  Fax: 765-868-4122

Business Mailing Address:
618 S MAIN ST  KOKOMO, IN 46901 US
Tel: 765-457-9313  Fax: 765-868-4122

Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)
X101YM0800XBehavioral Health & Social Service Providers
X101YP2500XBehavioral Health & Social Service Providers
X103TC0700XBehavioral Health & Social Service Providers
X1041C0700XBehavioral Health & Social Service Providers
Social Worker
X106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist


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