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NPI Code Detail

MEDICARE: MR. BOBBY CARBAGE MS, CRADC

MEDICARE: MR. BOBBY CARBAGE MS, CRADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorIL

General Provider Information

NPI Number : 1063785467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BOBBY CARBAGE MS, CRADC
Provider Business Mailing Address
First Line : 906 DAVIS ST
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3608
Country : US
Telephone Number : 847-492-1778
Fax Number :
Provider Business Practice Location Address
First Line : 906 DAVIS ST
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3608
Country : US
Telephone Number : 847-492-1778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2012
Last Update Date : 02/15/2012

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Directions to “ MR. BOBBY CARBAGE MS, CRADC” Practice Location

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