Provider Demographics
NPI:1215067889
Name:CONNECTIONS COUNSELING AND RESOURCE CENTER
Entity type:Organization
Organization Name:CONNECTIONS COUNSELING AND RESOURCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:WILBUR
Authorized Official - Last Name:TREADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-451-4503
Mailing Address - Street 1:712 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1621
Mailing Address - Country:US
Mailing Address - Phone:309-451-4503
Mailing Address - Fax:309-451-4503
Practice Address - Street 1:712 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1621
Practice Address - Country:US
Practice Address - Phone:309-451-4503
Practice Address - Fax:309-451-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490007451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL570310Medicare PIN