Basic Information
| Provider Information | |||||||||
| NPI: | 1053770198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLLIAS | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 VARSITY DRIVE | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477412600 | ||||||||
| FaxNumber: | 8477413248 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 VARSITY DRIVE | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477412600 | ||||||||
| FaxNumber: | 8477413248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2016 | ||||||||
| LastUpdateDate: | 02/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 14521 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.