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General NPI Number Information
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NPI Number | 1003280744
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Entity Type | Organization
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Legal Business Name | ANCHOR BEHAVIORAL CENTERS INC.
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 111 E CHESTNUT ST #48C
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City | CHICAGO
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State | IL
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Zip | 60611-2051
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Country | US
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Telephone | 312-254-5035
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Fax | 312-275-7775
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Provider Business Mailing Address
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Address Line | 79 W MONROE ST #920
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City | CHICAGO
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State | IL
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Zip | 60603-4901
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Country | US
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Telephone | 312-254-5035
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Fax | 312-275-7778
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Authorized Official
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Title or Position | SUBSTANCE ABUSE COUNSELOR/OWNER
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Name | NICOLE MONTALVO NELSON
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Credential | LCSW
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Telephone | 312-254-5035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.017479
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License Number State | IL
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