Constance Carr, MSW
Individual provider Active NPI Professional Counselor · Zion, IL
NPI 1790716694 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1790716694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- Practice address
- 2619 Elisha Ave
Zion, IL 60099-0603 - Phone
- (847) 746-0400
- Fax
- (847) 746-0403
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180-000275 | IL | MD | Professional Counselor |
| 1509-125 | WI | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1509-125 | WI | |
| Professional Counselor | 101YP2500X | IL | Yes |
Addresses
Primary practice location
2619 Elisha Ave
Zion, IL 60099-0603
Mailing address
2619 Elisha Ave
Zion, IL 60099-0603
Phone (847) 746-0400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43579700 | Medicaid | WI |
Other providers in Zion, IL
- Nicole Ann Breiling-Smith
- Brent C Paxton P C
- Annette C. S. Burmeister
- Barbara M. Buttin
- Alexandria Callahan
- Delgrashiea Shalon Carr
- Tami C Carrillo
- Charyl Casiano
- Cedar Hills Health & Rehab, LLC
- Crystal Chancey
All providers in Zion, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.