Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | IL |
NPI | 1003270703 |
---|---|
Provider Name | Ms. Dana Marie Aikens |
First Address | East Hazel Crest, IL 60429-1442 |
Second Address | East Hazel Crest, IL 60429-1442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 08/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22990 | MISA I (01) | IL |
3051 | ATE (01) | IL |
3051 | CSADC (01) |