Provider Demographics
NPI:1437413473
Name:ADAGIO COUNSELING AND INTERVENTION
Entity Type:Organization
Organization Name:ADAGIO COUNSELING AND INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TADD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHALLON
Authorized Official - Suffix:
Authorized Official - Credentials:LCAC
Authorized Official - Phone:317-313-0448
Mailing Address - Street 1:515 N GREEN ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2421
Mailing Address - Country:US
Mailing Address - Phone:317-852-3690
Mailing Address - Fax:317-852-2766
Practice Address - Street 1:515 N GREEN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2421
Practice Address - Country:US
Practice Address - Phone:317-852-3690
Practice Address - Fax:317-852-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000325A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty