Organization
MAINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID R. BILLINGHAM L.C.S.W. (ASSOCIATE DIRECTOR, PROFESSIONAL SE)
(847) 696-1570
Entity
Organization
Contact information
Practice address
832 BUSSE HWY, PARK RIDGE, IL 60068-2302
(847) 696-1570
(847) 696-1587
Mailing address
832 BUSSE HWY, PARK RIDGE, IL 60068-2302
(847) 696-1570
(847) 696-1587
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1615408
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
02/21/2008
Last updated
02/21/2008
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