Healthcare Provider Details

I. General information

NPI: 1124586144
Provider Name (Legal Business Name): DINHA FAROOQUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E SUPERIOR ST STE 306
CHICAGO IL
60611-2595
US

IV. Provider business mailing address

5250 SHOTKOSKI DR
HOFFMAN ESTATES IL
60192-4145
US

V. Phone/Fax

Practice location:
  • Phone: 312-754-9404
  • Fax:
Mailing address:
  • Phone: 847-840-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: