Provider Demographics
NPI:1740565126
Name:AFFILIATES IN COUNSELING LLC
Entity Type:Organization
Organization Name:AFFILIATES IN COUNSELING LLC
Other - Org Name:THE CENTER FOR DIVORCE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:847-480-0300
Mailing Address - Street 1:910 SKOKIE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4013
Mailing Address - Country:US
Mailing Address - Phone:847-480-0300
Mailing Address - Fax:847-291-0576
Practice Address - Street 1:910 SKOKIE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4013
Practice Address - Country:US
Practice Address - Phone:847-480-0300
Practice Address - Fax:847-291-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490129691041C0700X
IL166000576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty