Organization
COUNTERMEASURES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA LONG BA, CADC, MISA (DIRECTOR)
(309) 676-7868
Entity
Organization
Contact information
Practice address
456 FULTON ST, SUITE 271, PEORIA, IL 61602-1274
(309) 676-7868
(309) 839-2673
Mailing address
456 FULTON ST, SUITE 271, PEORIA, IL 61602-1274
(309) 676-7868
(309) 839-2673
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A-1028-0001-A
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
A-1028-0005-A
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
A-1028-0006-A
IL
Other
Enumeration date
04/10/2015
Last updated
06/11/2015
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