Healthcare Provider Details

I. General information

NPI: 1295004018
Provider Name (Legal Business Name): COUNSELING CENTER FOR EMOTIONAL GROWTH CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 N. LAKE SHORE DRIVE, UNIT 3010
CHICAGO IL
60613-5314
US

IV. Provider business mailing address

3660 N. LAKE SHORE DRIVE, UNIT 3010
CHICAGO IL
60613-5314
US

V. Phone/Fax

Practice location:
  • Phone: 708-373-1952
  • Fax: 312-643-1341
Mailing address:
  • Phone: 708-373-1952
  • Fax: 312-643-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. GEORGETTE ELAIINE LEPAGE
Title or Position: OWNER/PROVIDER
Credential: MS, LCPC
Phone: 847-967-0952