Healthcare Provider Details

I. General information

NPI: 1225119316
Provider Name (Legal Business Name): LINDA R PRICE CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH & ROOSEVELT
HINES IL
60141-5000
US

IV. Provider business mailing address

3466 WESTERN AVE
PARK FOREST IL
60466-1839
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-7013
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: