Provider Demographics
NPI:1619047297
Name:ASSOCIATES IN PROFESSIONAL COUNSELING CHARLES R POLCASTER PHD PC
Entity Type:Organization
Organization Name:ASSOCIATES IN PROFESSIONAL COUNSELING CHARLES R POLCASTER PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-448-0884
Mailing Address - Street 1:7804 W COLLEGE DR
Mailing Address - Street 2:2NE
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1025
Mailing Address - Country:US
Mailing Address - Phone:708-448-0884
Mailing Address - Fax:708-448-0594
Practice Address - Street 1:7804 W COLLEGE DR
Practice Address - Street 2:2NE
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1025
Practice Address - Country:US
Practice Address - Phone:708-448-0884
Practice Address - Fax:708-448-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060008046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632157OtherBLUE CROSS BLUE SHIELD