Healthcare Provider Details

I. General information

NPI: 1316614043
Provider Name (Legal Business Name): KADARRIOUS HOOKS BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 VICTORIA LN
CHARLESTON IL
61920-2964
US

IV. Provider business mailing address

1836 VICTORIA LN
CHARLESTON IL
61920-2964
US

V. Phone/Fax

Practice location:
  • Phone: 217-508-8080
  • Fax: 217-512-2288
Mailing address:
  • Phone: 217-508-8080
  • Fax: 217-512-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: