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2905 N Main St Decatur IL 62526-4274 | |
| (217) 877-9117 | |
| (217) 877-3082 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2905 N Main St, Decatur, Illinois |
| Authorized Official Name and Position | Rhonda Mitchell (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2178773290 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2905 N. Main Street Decatur IL 62526-4274 Ph: (217) 877-9117 | 2905 N Main St Decatur IL 62526-4274 Ph: (217) 877-9117 |
| NPI Number | 1770836991 |
|---|---|
| Provider Enumeration Date | 10/25/2012 |
| Last Update Date | 10/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770836991 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149.015497 (Illinois) | Primary |
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