Organization
PERRY COUNTY COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE BASTIEN (SUPPORT STAFF)
(618) 542-4357
Entity
Organization
Contact information
Practice address
1016 S MADISON ST, DU QUOIN, IL 62832-2442
(618) 542-4357
(618) 542-3442
Mailing address
1016 S MADISON ST, DU QUOIN, IL 62832-2442
(618) 542-4357
(618) 542-3442
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376130900001
—
IL
Enumeration date
01/02/2018
Last updated
01/02/2018
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