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General NPI Number Information
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NPI Number | 1801309752
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Entity Type | Organization
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Legal Business Name | SAFER FOUNDATION
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 2839 W FILLMORE ST
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City | CHICAGO
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State | IL
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Zip | 60612-4051
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Country | US
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Telephone | 773-638-8491
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Fax |
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Provider Business Mailing Address
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Address Line | 571 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60661-5701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | VICTOR DICKSON
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Credential |
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Telephone | 312-922-4767
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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 | 180.002611
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180.002611
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License Number State | IL
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