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General NPI Number Information
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NPI Number | 1760690978
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Entity Type | Organization
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Legal Business Name | A.D.D. CENTERS OF AMERICA LLC
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE SUITE 814
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-372-4824
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Fax | 312-372-4831
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE SUITE 814
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-372-4824
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Fax | 312-372-4831
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER JAKSA
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Credential | PH.D.
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Telephone | 312-372-4824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | IL
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