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General NPI Number Information
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NPI Number | 1134613748
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Entity Type | Organization
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Legal Business Name | NEW VISIONS COUNSELING CO.
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 6912 MAIN ST STE 201
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-3450
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Country | US
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Telephone | 630-493-1100
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Fax | 630-493-0942
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Provider Business Mailing Address
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Address Line | 1124 PARTRIDGE AVE
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City | BOLINGBROOK
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State | IL
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Zip | 60490-3108
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Country | US
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Telephone | 630-493-1100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TORI MEDINA
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Credential | CADC
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Telephone | 630-493-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | A-3689-0001-A
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License Number State | IL
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