| NPI | 1851441984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE ANITA FULLILOVE Clinical Psychologist 312-560-1808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-002239) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |