| NPI | 1679698526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN L CULLOP Owner 217-398-8067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 5466-0001) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-003901) |
| 101YP2500X Counselor, Professional (Licence: IL 180-002595) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |