Healthcare Provider Details

I. General information

NPI: 1427483411
Provider Name (Legal Business Name): FAMILY SERVICE:PREVENTION, EDUCATION & COUNSELING NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CENTRAL AVE SUITE 17
HIGHLAND PARK IL
60035-3240
US

IV. Provider business mailing address

777 CENTRAL AVE SUITE 17
HIGHLAND PARK IL
60035-3240
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-4981
  • Fax: 847-432-7331
Mailing address:
  • Phone: 847-432-4981
  • Fax: 847-432-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DIGNA RIVERA
Title or Position: COUNSELOR
Credential: MSW
Phone: 847-432-4981