Provider Demographics
NPI:1558732768
Name:CHARLENE THOBE SCOTT
Entity Type:Organization
Organization Name:CHARLENE THOBE SCOTT
Other - Org Name:RIVERWALK COUNSELING CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-848-0445
Mailing Address - Street 1:710 E OGDEN AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8602
Mailing Address - Country:US
Mailing Address - Phone:630-848-0445
Mailing Address - Fax:630-848-0455
Practice Address - Street 1:710 E OGDEN AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8602
Practice Address - Country:US
Practice Address - Phone:630-848-0445
Practice Address - Fax:630-848-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA52070001A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder