Healthcare Provider Details

I. General information

NPI: 1265004873
Provider Name (Legal Business Name): CARI COLLINS CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARO CHAMBERS

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S DEER RD
MACOMB IL
61455-2639
US

IV. Provider business mailing address

2323 WINDISH DR
GALESBURG IL
61401-9780
US

V. Phone/Fax

Practice location:
  • Phone: 309-344-2323
  • Fax: 309-344-4368
Mailing address:
  • Phone: 309-344-2323
  • Fax: 309-344-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number35337
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number35337
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: