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General NPI Number Information
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NPI Number | 1902333651
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Entity Type | Organization
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Legal Business Name | DEARBONE COUNSELING CENTER, INC
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 340 W BUTTERFIELD RD
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City | ELMHURST
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State | IL
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Zip | 60126-5069
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Country | US
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Telephone | 708-606-9895
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Fax | 708-449-5953
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Provider Business Mailing Address
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Address Line | 54 N WOLF RD
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City | HILLSIDE
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State | IL
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Zip | 60162-1630
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Country | US
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Telephone | 78-606-9895
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Fax | 708-449-5953
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Authorized Official
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Title or Position | CEO
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Name | DETRALL ARNELL DEARBONE-COLLINS
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Credential | MS
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Telephone | 708-606-9895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180004943
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License Number State | IL
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