Individual
CHARLES R POLCASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180000331
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632157
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/09/2006
Last updated
03/11/2014
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