Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003192261 |
---|---|
Provider Name | Mrs. Heather Sims |
First Address | Tunnel Hill, IL 62972-3149 |
Second Address | Marion, IL 62959-1139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2011 |
Last Update Date | 01/11/2011 |