Healthcare Provider Details

I. General information

NPI: 1740705946
Provider Name (Legal Business Name): SEA GLASS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MCLEAN ST
HUDSON IL
61748-7750
US

IV. Provider business mailing address

PO BOX 171
HUDSON IL
61748-0171
US

V. Phone/Fax

Practice location:
  • Phone: 309-740-1157
  • Fax:
Mailing address:
  • Phone: 309-740-1157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019425
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number149.019425
License Number StateIL

VIII. Authorized Official

Name: DARCI NEWTON
Title or Position: OWNER, LICENSED THERAPIST
Credential:
Phone: 309-740-1157