| NPI | 1851787493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA LONG Director 309-676-7868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL A-1028-0001-A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL A-1028-0005-A) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL A-1028-0006-A) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-06-11 |