MEDICARE: CORE COUNSELING AND CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1033860036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	5648 S HOYNE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-1132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5648 S HOYNE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-1132
Country	:	US
Telephone Number	:	773-577-3776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NNEKA COUNCIL
Credential	:	LCSW
Telephone Number	:	773-577-3776

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	01/12/2022

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