MEDICARE: UNITY COUNSELING CENTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1659687010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	5870 W. LAKE STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3888
Country	:	US
Telephone Number	:	773-261-0324
Fax Number	:	708-450-1713

Provider Business Practice Location Address
First Line	:	5870 W. LAKE STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3888
Country	:	US
Telephone Number	:	773-261-0324
Fax Number	:	708-450-1713

Authorized Official
Title or Position	:	PROGRAM COORDINATOR
Name	:	MISS DARLINE ANITA HENDERSON
Credential	:	MHP
Telephone Number	:	708-450-1707

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	09/08/2010

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Directions to “UNITY COUNSELING CENTER ” Practice Location

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