| NPI | 1790399319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA ELLEN FLEMING Billing Specialist 847-608-8570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 103TC1900X Psychologist Counseling | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |