Individual
FABIAN BRICE CHURCHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
6360 OLD HIGHWAY 13, CARBONDALE, IL 62901-5449
(815) 557-1433
(618) 997-7972
Mailing address
11264 IL-37, MARION, IL, IL 62959
(618) 997-2129
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
150.113927
IL
Other
Enumeration date
02/14/2025
Last updated
02/14/2025
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