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General NPI Number Information
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NPI Number | 1225490915
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Entity Type | Organization
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Legal Business Name | ACORN COUNSELING & MEDIATION, LTD
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 101 MCCAUSLAND ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-9133
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Country | US
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Telephone | 217-930-2106
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Fax | 217-716-2265
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Provider Business Mailing Address
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Address Line | 9 CRESTWOOD DR
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City | CARLINVILLE
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State | IL
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Zip | 62626-1847
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Country | US
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Telephone | 217-930-2106
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. WAYNE SPICER
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Credential | LCSW
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Telephone | 217-801-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.018235
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.016405
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License Number State | IL
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