Provider Demographics
NPI:1144498353
Name:ACADEMIC SOLUTIONS OF MICHIANA, INC
Entity type:Organization
Organization Name:ACADEMIC SOLUTIONS OF MICHIANA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABSNP
Authorized Official - Phone:574-273-2743
Mailing Address - Street 1:2012 IRONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1888
Mailing Address - Country:US
Mailing Address - Phone:574-273-2743
Mailing Address - Fax:
Practice Address - Street 1:2012 IRONWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1888
Practice Address - Country:US
Practice Address - Phone:574-273-2743
Practice Address - Fax:574-273-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty