Provider Demographics
NPI:1164269759
Name:NEVAREZ, VICTOR SR (CADC)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:NEVAREZ
Suffix:SR
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3729
Mailing Address - Country:US
Mailing Address - Phone:815-386-1308
Mailing Address - Fax:815-348-6883
Practice Address - Street 1:256 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3729
Practice Address - Country:US
Practice Address - Phone:815-386-1308
Practice Address - Fax:815-348-6883
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-4120-0001-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty