Healthcare Provider Details

I. General information

NPI: 1104583160
Provider Name (Legal Business Name): AKA COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 OGLESBY AVE STE 114A
NORMAL IL
61761-4616
US

IV. Provider business mailing address

3121 RIDGE CREST DR
BLOOMINGTON IL
61704-8307
US

V. Phone/Fax

Practice location:
  • Phone: 309-807-8669
  • Fax:
Mailing address:
  • Phone: 309-807-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALYA ABBED
Title or Position: OWNER/CLINICAL COUNSELOR
Credential: MA LCPC
Phone: 309-287-3583