Provider Demographics
NPI:1205438470
Name:JAMES, INDIRA DIN (MSW)
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:DIN
Last Name:JAMES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 ALOHA DR
Mailing Address - Street 2:
Mailing Address - City:WORDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62097-2214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3250 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2379
Practice Address - Country:US
Practice Address - Phone:531-315-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health