Provider Demographics
NPI:1851787493
Name:COUNTERMEASURES, INC.
Entity Type:Organization
Organization Name:COUNTERMEASURES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CADC, MISA
Authorized Official - Phone:309-676-7868
Mailing Address - Street 1:456 FULTON ST
Mailing Address - Street 2:SUITE 271
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1274
Mailing Address - Country:US
Mailing Address - Phone:309-676-7868
Mailing Address - Fax:309-839-2673
Practice Address - Street 1:456 FULTON ST
Practice Address - Street 2:SUITE 271
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1274
Practice Address - Country:US
Practice Address - Phone:309-676-7868
Practice Address - Fax:309-839-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-1028-0005-A101YA0400X
ILA-1028-0001-A101YA0400X
ILA-1028-0006-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty