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General NPI Number Information
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NPI Number | 1962657585
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Entity Type | Organization
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Legal Business Name | FOR THE CAUSE STI AWARENESS CHARITY, INC.
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 2200 HASSELL RD
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-2148
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Country | US
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Telephone | 847-802-8133
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 HASSELL RD
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-2148
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Country | US
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Telephone | 847-802-8133
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Fax |
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Authorized Official
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Title or Position | FOUNDER/COUNSELOR
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Name | MRS. OCTAVIA JARE'L COLEMAN
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Credential | MHSA
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Telephone | 919-455-3740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1085631
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 45175811
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 45175811
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 45175811
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 45175811
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License Number State | IL
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