Provider Demographics
NPI:1336760487
Name:JAMES, LORI ANN (BS, CADAC IV)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:JAMES
Suffix:
Gender:F
Credentials:BS, CADAC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 INDIAN WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-8673
Mailing Address - Country:US
Mailing Address - Phone:812-290-7401
Mailing Address - Fax:
Practice Address - Street 1:706 GREEN BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1506
Practice Address - Country:US
Practice Address - Phone:812-290-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC45003101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)