Healthcare Provider Details

I. General information

NPI: 1770262693
Provider Name (Legal Business Name): GHADEER COUNSELING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E LAKE ST STE 1B
ADDISON IL
60101-2877
US

IV. Provider business mailing address

211 E LAKE ST STE 1B
ADDISON IL
60101-2877
US

V. Phone/Fax

Practice location:
  • Phone: 773-817-5928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WAJAHATUDDIN MACCI
Title or Position: DIRECTOR
Credential:
Phone: 773-817-5928