Provider Demographics
NPI:1881168342
Name:EDUCATIONAL DESTINATIONS INC.
Entity type:Organization
Organization Name:EDUCATIONAL DESTINATIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, BS, MBA, MSM
Authorized Official - Phone:317-903-0122
Mailing Address - Street 1:4310 ABERDEEN CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-3202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:317-543-9870
Practice Address - Street 1:3349 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3859
Practice Address - Country:US
Practice Address - Phone:317-903-0122
Practice Address - Fax:317-543-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty