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General NPI Number Information
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NPI Number | 1609427269
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Entity Type | Organization
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Legal Business Name | WILLOW COUNSELING LLC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 1415 COBBLESTONE WAY
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City | CHAMPAIGN
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State | IL
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Zip | 61822-2068
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Country | US
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Telephone | 217-377-9347
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 COBBLESTONE WAY
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City | CHAMPAIGN
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State | IL
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Zip | 61822-2068
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Country | US
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Telephone | 217-377-9347
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Fax |
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Authorized Official
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Title or Position | LCPC
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Name | KRISTEN HAMMEL
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Credential | LCPC
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Telephone | 217-377-9347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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