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606 Eastgate St Suite A Carbondale IL 62901-3304 | |
| (618) 549-6984 | |
| (618) 549-9614 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 606 Eastgate St, Carbondale, Illinois |
| Authorized Official Name and Position | Julie Ann O'donnell (CO-OWNER) |
| Authorized Official Contact | 6185496984 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
606 Eastgate St Suite A Carbondale IL 62901-3304 Ph: (618) 549-6984 | 606 Eastgate St Suite A Carbondale IL 62901-3304 Ph: (618) 549-6984 |
| NPI Number | 1629125208 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629125208 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Illinois) | Primary |
| 1041C0700X | Social Worker - Clinical | (Illinois) | Primary |
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