Organization
THE CONSULTANT
Active
Organization
THE CONSULTANT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN S LAURITSEN MA.CSADC (COUNSELOR)
(309) 371-5777
Entity
Organization
Contact information
Practice address
311 E MAIN ST, SUITE 317, GALESBURG, IL 61401-4855
(309) 371-5777
Mailing address
311 E MAIN, SUITE 317, GALESBURG, IL 61401
(309) 371-5777
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A23960001A
IL
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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