Organization
INTENSIVE OUT-PATIENT CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER MARY MANNING LCSW (DIRECTOR)
(618) 656-7064
Entity
Organization
Contact information
Practice address
2 CLUB CENTRE CT, SUITE 1, EDWARDSVILLE, IL 62025-3503
(618) 656-7064
(618) 656-9084
Mailing address
2 CLUB CENTRE CT, SUITE 1, EDWARDSVILLE, IL 62025-3503
(618) 656-7064
(618) 656-9084
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
371259842
IL
Other
Enumeration date
07/20/2015
Last updated
07/20/2015
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