Provider Demographics
NPI:1073023776
Name:C.R. BOOKER MEDIATION & COUNSELING INC.
Entity Type:Organization
Organization Name:C.R. BOOKER MEDIATION & COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-552-4040
Mailing Address - Street 1:606 KREBS DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1105
Mailing Address - Country:US
Mailing Address - Phone:217-552-4040
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DR
Practice Address - Street 2:C-35
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7337
Practice Address - Country:US
Practice Address - Phone:217-552-4040
Practice Address - Fax:217-398-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0173101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1295107787OtherNPI