Provider Demographics
NPI:1023659612
Name:INDIGO WELLNESS, INC.
Entity type:Organization
Organization Name:INDIGO WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT
Authorized Official - Phone:302-450-3936
Mailing Address - Street 1:144 KINGS HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7308
Mailing Address - Country:US
Mailing Address - Phone:302-450-3936
Mailing Address - Fax:302-450-3927
Practice Address - Street 1:144 KINGS HWY STE 302
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7308
Practice Address - Country:US
Practice Address - Phone:302-450-3936
Practice Address - Fax:302-450-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)