Provider Demographics
NPI:1487032769
Name:ABBCON COUNSELING CORPORATION
Entity Type:Organization
Organization Name:ABBCON COUNSELING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CADC
Authorized Official - Phone:217-345-3156
Mailing Address - Street 1:603 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2034
Mailing Address - Country:US
Mailing Address - Phone:217-345-3156
Mailing Address - Fax:217-345-3157
Practice Address - Street 1:201 N LOGAN ST STE A
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4598
Practice Address - Country:US
Practice Address - Phone:217-317-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-6036-0004-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-6036-0013-AOtherSUPR LICENSE NUMBER