Healthcare Provider Details

I. General information

NPI: 1679846919
Provider Name (Legal Business Name): DREXEL COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 E 93RD ST
CHICAGO IL
60619-7814
US

IV. Provider business mailing address

1115 S PLYMOUTH CT APT 501
CHICAGO IL
60605-2032
US

V. Phone/Fax

Practice location:
  • Phone: 773-550-1696
  • Fax: 773-336-5545
Mailing address:
  • Phone: 773-550-1696
  • Fax: 312-753-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC/A42070002A
License Number StateIL

VIII. Authorized Official

Name: KATHY HARDIN EARL
Title or Position: EXECUTIVE DIRECTOR
Credential: MHS, CADC, CODP II
Phone: 773-550-1696