| Abc Counseling Pc | |
|
25283 W Timber Ln Lake Villa IL 60046-7372 | |
| (847) 587-2222 | |
| (847) 587-7656 |
| Full Name | Abc Counseling Pc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 25283 W Timber Ln, Lake Villa, Illinois |
| Authorized Official Name and Position | David Richard Mitchell (PRESIDENT) |
| Authorized Official Contact | 8475872222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Abc Counseling Pc 25283 W Timber Ln Lake Villa IL 60046-7372 Ph: (847) 587-2222 | Abc Counseling Pc 25283 W Timber Ln Lake Villa IL 60046-7372 Ph: (847) 587-2222 |
| NPI Number | 1407112576 |
|---|---|
| Provider Enumeration Date | 04/03/2012 |
| Last Update Date | 04/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407112576 | NPI | - | NPPES |
| 149-001264 | Other | LCSW | |
| 0660-006208 | Other | PRO. SERVICE CORP LIC. # | |
| 049-001264 | Other | BLUE SHIELD PROVIDER # | |
| L 2080-032716 | Other | TRICARE/CHAMPUS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 060-006208 (Illinois) | Primary |
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