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General NPI Number Information
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NPI Number | 1518855535
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Entity Type | Individual
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Provider Name | CEDRIC A BUSSIE LCPC
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 925 175TH ST STE 5
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City | HOMEWOOD
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State | IL
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Zip | 60430-2048
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Country | US
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Telephone | 773-570-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 3064 190TH ST
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City | LANSING
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State | IL
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Zip | 60438-3473
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Country | US
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Telephone | 773-597-8544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 180017181
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180017181
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180017181
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180017181
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License Number State | IL
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