Healthcare Provider Details

I. General information

NPI: 1275196917
Provider Name (Legal Business Name): S.A.C. DUI COUNSELING CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 76TH ST STE 326
CHICAGO IL
60620-1696
US

IV. Provider business mailing address

400 W 76TH ST STE 326
CHICAGO IL
60620-1696
US

V. Phone/Fax

Practice location:
  • Phone: 773-891-3653
  • Fax:
Mailing address:
  • Phone: 773-891-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SONJA ANN COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, MBA, CADC
Phone: 773-891-3653