| Constructive Changes Licensed Clinical Social Worker Services | |
|
44 E Main St Ste 406 Champaign IL 61820-3649 | |
| (217) 615-0350 | |
| Not Available |
| Full Name | Constructive Changes Licensed Clinical Social Worker Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 44 E Main St Ste 406, Champaign, Illinois |
| Authorized Official Name and Position | Alex Quintanilla (OWNER) |
| Authorized Official Contact | 2176150350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Constructive Changes Licensed Clinical Social Worker Services 1717 W Kirby Ave Unit 306 Champaign IL 61821-5507 Ph: (217) 615-0350 | Constructive Changes Licensed Clinical Social Worker Services 44 E Main St Ste 406 Champaign IL 61820-3649 Ph: (217) 615-0350 |
| NPI Number | 1417630757 |
|---|---|
| Provider Enumeration Date | 08/14/2023 |
| Last Update Date | 08/14/2023 |
| Certification Date | 07/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417630757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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