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General NPI Number Information
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NPI Number | 1679382204
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Entity Type | Organization
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Legal Business Name | LIFELINE COUNSELING CENTER INC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1655 N ARLINGTON HEIGHTS RD STE 301W
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-3900
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Country | US
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Telephone | 847-626-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 424 N THORNWOOD DR
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City | MCHENRY
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State | IL
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Zip | 60050-5031
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Country | US
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Telephone | 847-626-5001
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | BRENDAN WAGNER
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Credential |
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Telephone | 773-554-5041
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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