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General NPI Number Information
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NPI Number | 1578775052
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Entity Type | Organization
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Legal Business Name | KING DRIVE COUNSELING, INC.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 370 EAST 63RD STREET
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City | CHICAGO
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State | IL
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Zip | 60637
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Country | US
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Telephone | 773-324-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 370 EAST 63RD STREET
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City | CHICAGO
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State | IL
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Zip | 60637
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Country | US
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Telephone | 773-324-5500
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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 | MR. JAMES E. SMITH
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Credential | M.A.,CARS
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Telephone | 773-324-5500
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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 | A-0164-0002-A
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License Number State | IL
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