| NPI | 1992261424 |
|---|---|
| Former Legal Business Name | MY SANCTUARY SHOP |
| Entity Type | Organization |
| Authorized Contact | KATHLEEN A DURBIN Practice Owner 312-925-1947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |