Organization
CONSTRUCTIVE CHANGES LICENSED CLINICAL SOCIAL WORKER SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX QUINTANILLA (OWNER)
(217) 615-0350
Entity
Organization
Contact information
Practice address
44 E MAIN ST STE 406, CHAMPAIGN, IL 61820-3649
(217) 615-0350
Mailing address
1717 W KIRBY AVE UNIT 306, CHAMPAIGN, IL 61821-5507
(217) 615-0350
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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