Provider Demographics
NPI:1962657585
Name:FOR THE CAUSE STI AWARENESS CHARITY, INC.
Entity Type:Organization
Organization Name:FOR THE CAUSE STI AWARENESS CHARITY, INC.
Other - Org Name:FTC CHARITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:JARE'L
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:919-455-3740
Mailing Address - Street 1:2200 HASSELL RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2148
Mailing Address - Country:US
Mailing Address - Phone:847-802-8133
Mailing Address - Fax:
Practice Address - Street 1:2200 HASSELL RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2148
Practice Address - Country:US
Practice Address - Phone:847-802-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL45175811101YM0800X, 251B00000X, 302R00000X, 305S00000X
NC1085631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty