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Organization
SOUTH EASTERN ILLINOIS COUNSELING CENTER INC
Active
Organization
SOUTH EASTERN ILLINOIS COUNSELING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN JACKSON M.DIV., LSW, LCPC (EXECUTIVE DIRECTOR)
(618) 395-4309
Entity
Organization
Contact information
Practice address
504 MICAH DRIVE, DRAWER M, OLNEY, IL 62450
(618) 395-4306
(618) 395-4507
Mailing address
PO BOX M, 504 MICAH DRIVE, OLNEY, IL 62450-0913
(618) 395-4306
(618) 395-4507
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036037359
—
IL
05
—
036072942
—
IL
05
—
343700207
—
IL
Enumeration date
10/06/2005
Last updated
05/05/2016
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