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General NPI Number Information
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NPI Number | 1386395952
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Entity Type | Organization
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Legal Business Name | SINCLAIR COUNSELING & THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 5016 N UNIVERSITY ST STE 101
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City | PEORIA
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State | IL
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Zip | 61614-4763
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Country | US
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Telephone | 309-863-5590
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Fax | 309-453-6276
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Provider Business Mailing Address
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Address Line | 119 STONECROP RD
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City | MORTON
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State | IL
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Zip | 61550-3155
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Country | US
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Telephone | 309-863-5590
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Fax | 309-453-6276
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. ANGELA KRISTI SINCLAIR HAWLEY
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Credential | LCSW
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Telephone | 309-863-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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