Provider Demographics
NPI:1649696774
Name:CRAB ORCHARD COUNSELING LLC
Entity type:Organization
Organization Name:CRAB ORCHARD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-894-0218
Mailing Address - Street 1:4501 W DEYOUNG ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6360
Mailing Address - Country:US
Mailing Address - Phone:618-967-4890
Mailing Address - Fax:815-846-0744
Practice Address - Street 1:4501 W DEYOUNG ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6360
Practice Address - Country:US
Practice Address - Phone:618-967-4890
Practice Address - Fax:815-846-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490143981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty