Provider Demographics
NPI:1326111444
Name:EDT, INC.
Entity Type:Organization
Organization Name:EDT, INC.
Other - Org Name:WE CARE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCSW
Authorized Official - Phone:260-422-3034
Mailing Address - Street 1:509 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2917
Mailing Address - Country:US
Mailing Address - Phone:260-422-3034
Mailing Address - Fax:260-422-3691
Practice Address - Street 1:509 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2917
Practice Address - Country:US
Practice Address - Phone:260-422-3034
Practice Address - Fax:260-422-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN666690Medicare ID - Type UnspecifiedMEDICAID GROUP ID #