Provider Demographics
NPI:1710280714
Name:ABC COUNSELING AND FAMILY SERVICES
Entity Type:Organization
Organization Name:ABC COUNSELING AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCSW
Authorized Official - Phone:309-451-9495
Mailing Address - Street 1:705 E LINCOLN ST
Mailing Address - Street 2:STE 303
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6406
Mailing Address - Country:US
Mailing Address - Phone:309-451-9495
Mailing Address - Fax:309-451-9495
Practice Address - Street 1:2160 S 6TH ST
Practice Address - Street 2:STE A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-3459
Practice Address - Country:US
Practice Address - Phone:217-528-9820
Practice Address - Fax:217-528-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490136151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty