Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1336264753 |
---|---|
Provider Name | Dr. Charles Edgar Alcorn III |
First Address | Carol Stream, IL 60188-2706 |
Second Address | Carol Stream, IL 60188-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |