Provider Demographics
NPI:1487856688
Name:CALE, GINA (NCAC II, LCAC, MCAC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CALE
Suffix:
Gender:F
Credentials:NCAC II, LCAC, MCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3868
Mailing Address - Country:US
Mailing Address - Phone:765-662-9971
Mailing Address - Fax:765-651-6556
Practice Address - Street 1:101 S WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3868
Practice Address - Country:US
Practice Address - Phone:765-662-9971
Practice Address - Fax:765-651-6556
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101Y00000X
IN87000954A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100124250Medicaid