Healthcare Provider Details

I. General information

NPI: 1194195024
Provider Name (Legal Business Name): SONIA DUBOSE MSW, LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONIA DUBOSE

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 09/29/2026
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 N DILLEYS RD
GURNEE IL
60031-1711
US

IV. Provider business mailing address

PO BOX 22
NORTH CHICAGO IL
60064-0022
US

V. Phone/Fax

Practice location:
  • Phone: 312-608-7369
  • Fax:
Mailing address:
  • Phone: 312-608-7369
  • Fax: 847-984-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number150.108061
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number36580
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.027190
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.108061
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027190
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: