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General NPI Number Information
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NPI Number | 1104583160
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Entity Type | Organization
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Legal Business Name | AKA COUNSELING CENTER LLC
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 706 OGLESBY AVE STE 114A
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City | NORMAL
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State | IL
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Zip | 61761-4616
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Country | US
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Telephone | 309-807-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 3121 RIDGE CREST DR
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City | BLOOMINGTON
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State | IL
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Zip | 61704-8307
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Country | US
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Telephone | 309-807-8669
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL COUNSELOR
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Name | MRS. ALYA ABBED
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Credential | MA LCPC
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Telephone | 309-287-3583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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