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1029 N Water St Decatur IL 62523-1022 | |
| (217) 362-6262 | |
| (217) 362-6290 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1029 N Water St, Decatur, Illinois |
| Authorized Official Name and Position | Candace Clevenger (PRESIDENT/CEO) |
| Authorized Official Contact | 2173626262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
151 N Main St Decatur IL 62523-1206 Ph: (217) 362-6262 | 1029 N Water St Decatur IL 62523-1022 Ph: (217) 362-6262 |
| NPI Number | 1821540865 |
|---|---|
| Provider Enumeration Date | 10/25/2016 |
| Last Update Date | 12/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821540865 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | A-0200-0004-A (Illinois) | Primary |
A & E Behavioral Health Care Associates Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2570 Federal Drive, Decatur, IL 62526 Phone: 217-872-1003 Fax: 217-233-4150 | |
Armor Bearer Services Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 861 W William St, Decatur, IL 62522 Phone: 217-402-4226 | |
Decatur Psychological Associates Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3040 N University Ave, Suite 2, Decatur, IL 62526 Phone: 217-872-1700 Fax: 217-872-1366 |