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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