Organization
BACK TO BASICS COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYMIE L MCCAMMON (LCSW)
(779) 220-0441
Entity
Organization
Contact information
Practice address
106 N MAIN ST, DECATUR, IL 62523-1207
(217) 821-8269
Mailing address
106 N MAIN ST, DECATUR, IL 62523-1207
(779) 220-0441
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194099853
NPI 1
IL
Enumeration date
06/04/2020
Last updated
07/17/2020
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