Provider Demographics
NPI:1225119316
Name:PRICE, LINDA R (CADC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:R
Last Name:PRICE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1839
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:708-202-7013
Practice Address - Street 1:5TH & ROOSEVELT
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)