Individual
DARRELL DONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
411 W DIVISION ST, MANTENO, IL 60950-1065
(815) 432-5241
Mailing address
PO BOX 322, WATSEKA, IL 60970-0322
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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