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General NPI Number Information
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NPI Number | 1235423427
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Entity Type | Organization
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Legal Business Name | LEVERENZ COUNSELING AND WELLNESS SERVICES
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Dates
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Enumeration Date | 06/05/2011
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Last Update Date | 06/05/2011
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Provider Practice Location Address
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Address Line | 408 N VERMILION ST
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City | DANVILLE
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State | IL
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Zip | 61832-4648
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Country | US
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Telephone | 217-446-6848
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Fax | 217-446-6850
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Provider Business Mailing Address
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Address Line | 408 N VERMILION ST
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City | DANVILLE
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State | IL
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Zip | 61832-4648
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Country | US
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Telephone | 217-446-6848
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Fax | 217-446-6850
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MRS. CANDACE ELIZABETH LEVERENZ
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Credential | MSW, LCSW
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Telephone | 217-446-6848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 149011254
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License Number State | IL
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