Provider Demographics
NPI:1639462948
Name:RADZOM COUNSELING LLC
Entity Type:Organization
Organization Name:RADZOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RADZOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:618-248-2040
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-0101
Mailing Address - Country:US
Mailing Address - Phone:618-248-2040
Mailing Address - Fax:618-248-2040
Practice Address - Street 1:40B EDWARDSVILLE PROF PARK
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3602
Practice Address - Country:US
Practice Address - Phone:618-248-2040
Practice Address - Fax:618-248-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490127061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty