Healthcare Provider Details

I. General information

NPI: 1043137508
Provider Name (Legal Business Name): NEW BIRTH COUNSELING AND COMMUNITY WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9608 S UNION AVE
CHICAGO IL
60628-1017
US

IV. Provider business mailing address

9624 S CICERO AVE # 234
OAK LAWN IL
60453-3138
US

V. Phone/Fax

Practice location:
  • Phone: 773-307-8441
  • Fax:
Mailing address:
  • Phone: 773-307-8441
  • Fax:

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 Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRE T JOHNSON
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 773-307-8441