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General NPI Number Information
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NPI Number | 1063645612
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Entity Type | Organization
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Legal Business Name | HELLEN G. MCDONALD
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 44 E MAIN STREET #505
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City | CHAMPAIGN
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State | IL
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Zip | 61820
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Country | US
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Telephone | 217-378-8575
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Fax |
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Provider Business Mailing Address
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Address Line | 44 E MAIN ST #505
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3636
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Country | US
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Telephone | 217-378-8575
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | MRS. HELLEN G MCDONALD
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Credential | LCSW
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Telephone | 217-378-8575
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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 | 149009801
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License Number State | IL
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