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General NPI Number Information
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NPI Number | 1003356742
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Entity Type | Individual
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Provider Name | ANTHONY DILLARD SR. NCRS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 995 BODE RD
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City | ELGIN
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State | IL
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Zip | 60120-4523
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Country | US
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Telephone | 224-238-3279
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Fax | 224-238-3279
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Provider Business Mailing Address
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Address Line | 394 MADISON AVE
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City | CALUMET CITY
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State | IL
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Zip | 60409-2107
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Country | US
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Telephone | 708-868-5014
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Fax | 708-868-8335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A-8723-0002-A
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License Number State | IL
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