Individual
ANDRE D NEWSOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, MS, MHS, CADC
Contact information
Practice address
1100 W CERMAK RD, CHICAGO, IL 60608-4500
(312) 568-7051
Mailing address
1100 W CERMAK RD, CHICAGO, IL 60608-4500
(312) 568-7051
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273984627001
—
IL
Enumeration date
06/27/2017
Last updated
07/21/2022
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