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General NPI Number Information
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NPI Number | 1407112576
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Entity Type | Organization
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Legal Business Name | ABC COUNSELING PC
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 25283 W TIMBER LN
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City | LAKE VILLA
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State | IL
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Zip | 60046-7372
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Country | US
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Telephone | 847-587-2222
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Fax | 847-587-7656
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Provider Business Mailing Address
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Address Line | 25283 W TIMBER LN
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City | LAKE VILLA
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State | IL
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Zip | 60046-7372
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Country | US
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Telephone | 847-587-2222
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Fax | 847-587-7656
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID RICHARD MITCHELL
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Credential | MSW, LCSW
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Telephone | 847-587-2222
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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 | 060-006208
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License Number State | IL
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