Healthcare Provider Details

I. General information

NPI: 1982155255
Provider Name (Legal Business Name): ANC COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST SUITE 205A
CHICAGO IL
60611-2926
US

IV. Provider business mailing address

233 E ERIE ST SUITE 205A
CHICAGO IL
60611-2926
US

V. Phone/Fax

Practice location:
  • Phone: 773-609-2358
  • Fax:
Mailing address:
  • Phone: 773-609-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012219.
License Number StateIL

VIII. Authorized Official

Name: ALLYSON COPPIN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 773-609-2358