Provider Demographics
NPI:1780259416
Name:MCGUIRE, ANNIE NOELLE (LCSW, CSAYC)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:NOELLE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:LCSW, CSAYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62226 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-9438
Mailing Address - Country:US
Mailing Address - Phone:574-202-4672
Mailing Address - Fax:
Practice Address - Street 1:62226 COUNTY ROAD 15
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-9438
Practice Address - Country:US
Practice Address - Phone:574-202-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009295A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical