Provider Demographics
NPI:1629194501
Name:MCELLIN, DEBORAH MARY (BS,CADC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MARY
Last Name:MCELLIN
Suffix:
Gender:F
Credentials:BS,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S RAND ROAD
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3148
Mailing Address - Country:US
Mailing Address - Phone:630-833-6033
Mailing Address - Fax:
Practice Address - Street 1:675 VARSITY DRIVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-8176
Practice Address - Country:US
Practice Address - Phone:847-741-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19967101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)