Healthcare Provider Details

I. General information

NPI: 1588757231
Provider Name (Legal Business Name): ADVOCATES IN CLINICAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 BOULDER BLUFF LANE
ALGONQUIN IL
60102
US

IV. Provider business mailing address

1470 BOULDER BLUFF LANE
ALGONQUIN IL
60102
US

V. Phone/Fax

Practice location:
  • Phone: 847-551-1820
  • Fax:
Mailing address:
  • Phone: 847-551-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009033
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. TINA LOGA
Title or Position: OWNER
Credential: LCSW
Phone: 847-551-1820