Provider Demographics
NPI: | 1962926626 |
---|---|
Name: | CENTER OF ATTENTION COUNSELING SERVICES, LLC |
Entity type: | Organization |
Organization Name: | CENTER OF ATTENTION COUNSELING SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL THERAPIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALICEA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BAILEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 630-687-0693 |
Mailing Address - Street 1: | PO BOX 158 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOLINGBROOK |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60440-0143 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 215 REMINGTON BLVD STE G2 |
Practice Address - Street 2: | |
Practice Address - City: | BOLINGBROOK |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60440-3663 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-687-0693 |
Practice Address - Fax: | 630-596-1622 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-08-03 |
Last Update Date: | 2017-08-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 30051 | 101YA0400X, 261QR0405X, 276400000X, 3245S0500X |
IL | 180.00998 | 101YM0800X, 101YP2500X, 261QM0850X |
IL | 180.009998 | 261QM0801X, 261QM0855X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
No | 276400000X | Hospital Units | Rehabilitation, Substance Use Disorder Unit | ||
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | Group - Multi-Specialty |