Provider Demographics
NPI:1518283183
Name:DEARBONE-COLLINS, DETRALL ARNELL (MS)
Entity Type:Individual
Prefix:MRS
First Name:DETRALL
Middle Name:ARNELL
Last Name:DEARBONE-COLLINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-1630
Mailing Address - Country:US
Mailing Address - Phone:708-449-5953
Mailing Address - Fax:
Practice Address - Street 1:54 N WOLF RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1630
Practice Address - Country:US
Practice Address - Phone:708-606-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004943101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)