Basic Information
Provider Information
NPI: 1083020903
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARMOUR
FirstName: CORAL
MiddleName: JEANNE
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1025 S 6TH ST
Address2:  
City: SPRINGFIELD
State: IL
PostalCode: 627032403
CountryCode: US
TelephoneNumber: 2175287541
FaxNumber:  
Practice Location
Address1: 15 FOUNDERS LN
Address2:  
City: JACKSONVILLE
State: IL
PostalCode: 626503919
CountryCode: US
TelephoneNumber: 2172911041
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/11/2014
LastUpdateDate: 05/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X149015262ILY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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