Provider Demographics
NPI:1114143815
Name:MCCAMMACK, ALISON LEIGH (BS,CADC,MISA I)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:LEIGH
Last Name:MCCAMMACK
Suffix:
Gender:F
Credentials:BS,CADC,MISA I
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:LEIGH
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11191 ILLINOIS ROUTE 185
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-2664
Mailing Address - Country:US
Mailing Address - Phone:217-532-2001
Mailing Address - Fax:217-532-6361
Practice Address - Street 1:11191 ILLINOIS ROUTE 185
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-2664
Practice Address - Country:US
Practice Address - Phone:217-532-2001
Practice Address - Fax:217-532-6361
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23745101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health