Healthcare Provider Details

I. General information

NPI: 1326456484
Provider Name (Legal Business Name): CARBONDALE COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W COMMERCIAL DR STE H
CARTERVILLE IL
62918-2057
US

IV. Provider business mailing address

PO BOX 2625
CARBONDALE IL
62902-2625
US

V. Phone/Fax

Practice location:
  • Phone: 618-351-9700
  • Fax: 618-351-9701
Mailing address:
  • Phone: 618-351-9700
  • Fax: 618-351-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE SCHWARTZ
Title or Position: OWNER
Credential: LCPC
Phone: 618-351-9700