Healthcare Provider Details

I. General information

NPI: 1447168653
Provider Name (Legal Business Name): CHARLI NORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 N DAMEN AVE
CHICAGO IL
60618-3969
US

IV. Provider business mailing address

1433 W GRANVILLE AVE
CHICAGO IL
60660-1809
US

V. Phone/Fax

Practice location:
  • Phone: 773-423-8447
  • Fax:
Mailing address:
  • Phone: 312-806-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: