Provider Demographics
NPI:1467724211
Name:KD COUNSELING
Entity Type:Organization
Organization Name:KD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIFILIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LCSW
Authorized Official - Phone:217-369-9183
Mailing Address - Street 1:1205 RIVERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-3503
Mailing Address - Country:US
Mailing Address - Phone:217-369-9183
Mailing Address - Fax:
Practice Address - Street 1:1205 RIVERSIDE CT
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-3503
Practice Address - Country:US
Practice Address - Phone:217-369-9183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.013492251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104981067OtherNPI