| NPI | 1699545079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA LANE Lcsw 312-248-4460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2025-05-14 |