=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518382977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A NEW DAY COUNSELING CENTER LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2014
-----------------------------------------------------
Last Update Date | 10/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 E 22ND ST STE 302
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-6106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-853-0766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 E. 22ND ST. SUITE 150
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-6106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-853-0766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. DAWN M BOETTGER
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 630-853-0766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 180.008643
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------