KALVIN FORTENBERRY

EAST HAZEL CREST, IL
NPI1912361742
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: IL  15408)
Enumeration Date2016-04-07
Last Update Date2016-04-07
Business Address
-- KALVIN FORTENBERRY MA CAADC ATE
1909 CHEKER SQ
EAST HAZEL CREST, IL 60429-1442
Phone number: 708-647-3333
Mailing Address
-- KALVIN FORTENBERRY MA CAADC ATE
1909 CHEKER SQ
EAST HAZEL CREST, IL 60429-1442
Phone number: 708-647-3333
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