| NPI | 1710952221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODRIGO A MANJARRES Clinical Director 847-360-8860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180002842) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2019-09-20 |