Provider Demographics
NPI:1225490915
Name:ACORN COUNSELING & MEDIATION, LTD
Entity Type:Organization
Organization Name:ACORN COUNSELING & MEDIATION, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-801-1242
Mailing Address - Street 1:9 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1847
Mailing Address - Country:US
Mailing Address - Phone:217-930-2106
Mailing Address - Fax:
Practice Address - Street 1:101 MCCAUSLAND ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-9133
Practice Address - Country:US
Practice Address - Phone:217-930-2106
Practice Address - Fax:217-716-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.016405251S00000X
IL149.018235251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health