Doctor Name: | ALICEA BUSH |
NPI Number: | 1083905426 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 30051 |
Business Practice Address: | 530 Sundance Dr Bolingbrook, IL - 604401741 |
Business Phone Number: | 6307591889 |
Business Fax Number: | 6307591889 |
Mailing Address: | 530 Sundance Dr, BOLINGBROOK |
State: | IL |
Postal Code: | 604401741 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/19/2011 |
NPI Last Update Date: | 01/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 30051 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |