Healthcare Provider Details

I. General information

NPI: 1164168969
Provider Name (Legal Business Name): HAWK-TORCH COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S CANAL ST # 1411
CHICAGO IL
60607-4907
US

IV. Provider business mailing address

1130 S CANAL ST # 1411
CHICAGO IL
60607-4907
US

V. Phone/Fax

Practice location:
  • Phone: 773-915-3588
  • Fax:
Mailing address:
  • Phone: 773-915-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: COZETTE MICHELLE ROPER
Title or Position: CLINICAN/OWNER
Credential: LCSW
Phone: 773-915-3588