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General NPI Number Information
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NPI Number | 1275196917
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Entity Type | Organization
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Legal Business Name | S.A.C. DUI COUNSELING CENTER, LLC.
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 400 W 76TH ST STE 326
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City | CHICAGO
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State | IL
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Zip | 60620-1696
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Country | US
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Telephone | 773-891-3653
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W 76TH ST STE 326
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City | CHICAGO
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State | IL
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Zip | 60620-1696
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Country | US
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Telephone | 773-891-3653
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SONJA ANN COLLINS
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Credential | MA, MBA, CADC
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Telephone | 773-891-3653
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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 |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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