Provider Demographics
NPI:1720775893
Name:CARBONDALE DUI & COUNSELING ASSOCIATES, INC.
Entity type:Organization
Organization Name:CARBONDALE DUI & COUNSELING ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRASSL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:618-993-3013
Mailing Address - Street 1:502 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2816
Mailing Address - Country:US
Mailing Address - Phone:618-993-3013
Mailing Address - Fax:618-998-8018
Practice Address - Street 1:502 S COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2816
Practice Address - Country:US
Practice Address - Phone:618-993-3013
Practice Address - Fax:618-998-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty