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NPI Code Detail

MEDICARE: DUAINE CARLTON LCPC

MEDICARE: DUAINE CARLTON LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorIL

General Provider Information

NPI Number : 1881654358
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUAINE CARLTON LCPC
Provider Business Mailing Address
First Line : 1712 W ADAMS ST
Second Line :
City : HERRIN
State : IL
Zip : 62948-1329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 109 LOU ANN DR
Second Line :
City : HERRIN
State : IL
Zip : 62948-3733
Country : US
Telephone Number : 618-988-1330
Fax Number : 618-988-8321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2006
Last Update Date : 07/08/2007

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Directions to “ DUAINE CARLTON LCPC” Practice Location

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