National Provider Identifier
180 Enterprise
180 Enterprise is listed in the NPPES registry with a primary specialty of Addiction (Substance Use Disorder) Counselor in Indianapolis, IN and a listed phone number of (317) 966-7772.
Source: public NPPES record, last updated December 27, 2020. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.
Profile Overview
- NPI
- 1619564549
- Provider Type
- Organization
- Primary Specialty
- Addiction (Substance Use Disorder) Counselor
- Enumeration Date
- December 27, 2020
- Last Updated
- December 27, 2020
Practice Location
- 3430 Cork Bend Dr
- Indianapolis, IN 46239-7669
Phone: (317) 966-7772
Authorized Official
- Name
- Mrs. Kimtoiya Sam
- Title
- Owner
- Credentials
- LCAC
- Phone
- (317) 966-7772
Specialties
- Addiction (Substance Use Disorder) Counselor (101YA0400X)
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Full Record
- NPI
- 1619564549
- Entity Type
- Organization
- Organization Name
- 180 Enterprise
- Mailing Street Address
- 3430 Cork Bend Dr
- Mailing City
- Indianapolis
- Mailing State
- IN
- Mailing ZIP Code
- 46239-7669
- Mailing Country
- US
- Mailing Phone
- (317) 966-7772
- Practice Street Address
- 3430 Cork Bend Dr
- Practice City
- Indianapolis
- Practice State
- IN
- Practice ZIP Code
- 46239-7669
- Practice Country
- US
- Practice Phone
- (317) 966-7772
- Enumeration Date
- December 27, 2020
- Last Updated
- December 27, 2020
- Authorized Official Last Name
- Sam
- Authorized Official First Name
- Kimtoiya
- Authorized Official Title
- Owner
- Authorized Official Phone
- (317) 966-7772
- Organization Subpart
- No
- Authorized Official Name Prefix Text
- Mrs.
- Authorized Official Credential Text
- LCAC
- Taxonomy Group 1
- 193400000X Single Specialty Group
- Certification Date
- December 27, 2020
- Taxonomies
- Addiction (Substance Use Disorder) Counselor (101YA0400X)