Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 19151 | IL |
NPI | 1003180506 |
---|---|
Provider Name | Linda Metts |
First Address | Waukegan, IL 60085-2321 |
Second Address | Waukegan, IL 60085-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2012 |
Last Update Date | 29/02/2012 |