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Organization
COUNTY OF LAKE
Active
Organization
COUNTY OF LAKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM JOHNSON (DEPUTY EXECUTIVE DIRECTOR)
(847) 377-8000
Entity
Organization
Contact information
Practice address
3170 W GRANDVILLE AVE, WAUKEGAN, IL 60085-8420
(847) 377-8000
Mailing address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8000
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/23/2026
Last updated
08/31/2026
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