Organization
ABC COUNSELING PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID RICHARD MITCHELL MSW, LCSW (PRESIDENT)
(847) 587-2222
Entity
Organization
Contact information
Practice address
25283 W TIMBER LN, LAKE VILLA, IL 60046-7372
(847) 587-2222
(847) 587-7656
Mailing address
25283 W TIMBER LN, LAKE VILLA, IL 60046-7372
(847) 587-2222
(847) 587-7656
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
060-006208
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049-001264
BLUE SHIELD PROVIDER #
—
01
—
0660-006208
PRO. SERVICE CORP LIC. #
—
01
—
149-001264
LCSW
—
01
—
L 2080-032716
TRICARE/CHAMPUS
—
Enumeration date
04/03/2012
Last updated
04/09/2012
Update your record
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