| NPI | 1427463405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA WALLACE Provider 708-906-0205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.008731) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.008731) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180.008731) | |
| 101YP1600X Counselor, Pastoral (Licence: IL 180.008731) | |
| 101YP2500X Counselor, Professional (Licence: IL 180.008731) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 180.008731) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2014-06-27 |