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General NPI Number Information
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NPI Number | 1669701389
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Entity Type | Organization
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Legal Business Name | DUI & ADDICTION COUNSELING CENTER
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 333 E. ILLINOIS ROUTE 83 B7
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City | MUNDELEIN
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State | IL
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Zip | 60060
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Country | US
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Telephone | 847-949-4596
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Fax | 847-949-4598
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Provider Business Mailing Address
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Address Line | 333 E. ILLINOIS ROUTE 83 B7
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City | MUNDELEIN
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State | IL
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Zip | 60060
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Country | US
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Telephone | 847-949-4596
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Fax | 847-949-4598
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. BARRY EDWARD HINKELDEY
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Credential | CADC
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Telephone | 847-949-4596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A14580001A
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | A14580001A
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License Number State | IL
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