Organization
ROCKFORD ANXIETY AND PHOBIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES DOY DUDLEY JR. M.ED (OWNER)
(815) 762-0903
Entity
Organization
Contact information
Practice address
429 PHELPS AVE, BUILDING 7 SUITE 11, ROCKFORD, IL 61108-2493
(815) 762-0903
(779) 500-0687
Mailing address
429 PHELPS AVE, BUILDING 7 SUITE 11, ROCKFORD, IL 61108-2493
(815) 762-0903
(779) 500-0687
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
180000119
IL
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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