Individual
JOHN ROBERT PRAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
900 S DEER RD, MACOMB, IL 61455-2639
(309) 837-4876
(309) 833-1531
Mailing address
PO BOX 566, AVON, IL 61415-0566
(309) 465-3949
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
22822
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
22822
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22822
CADC
IL
01
—
370984175
FEIN BWAY, INC
IL
Enumeration date
04/06/2007
Last updated
04/14/2009
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