Provider Demographics
NPI:1124316468
Name:CLINICAL COUNSELING GROUP & DUI PROVIDERS, LLC
Entity type:Organization
Organization Name:CLINICAL COUNSELING GROUP & DUI PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-725-0039
Mailing Address - Street 1:701 S DURKIN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6029
Mailing Address - Country:US
Mailing Address - Phone:217-726-7575
Mailing Address - Fax:217-726-7577
Practice Address - Street 1:701 S DURKIN DR
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6029
Practice Address - Country:US
Practice Address - Phone:217-726-7575
Practice Address - Fax:217-726-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health