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Organization
RAINBOW CAFE LGBTQ CENTER
Active
Organization
RAINBOW CAFE LGBTQ CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER R SOCORRO (DIRECTOR)
(618) 525-9922
Entity
Organization
Contact information
Practice address
120 N ILLINOIS AVE, CARBONDALE, IL 62901-1450
(618) 525-9922
Mailing address
118 N ILLINOIS AVE, CARBONDALE, IL 62901-1450
(618) 525-9922
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BHC-2427502
—
IL
Enumeration date
08/04/2023
Last updated
07/16/2026
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