| NPI | 1316083231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAISE JOSEPH WOLFRUM Medical Director 847-895-4540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical (Licence: IL 036079918) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2022-07-21 |