Healthcare Provider Details

I. General information

NPI: 1942445671
Provider Name (Legal Business Name): INNOVATIVE SOCIAL WORK SOLUTIONS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST STE 610
CHICAGO IL
60611-5934
US

IV. Provider business mailing address

233 E ERIE ST STE 610
CHICAGO IL
60611-5934
US

V. Phone/Fax

Practice location:
  • Phone: 773-255-0672
  • Fax:
Mailing address:
  • Phone: 773-255-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2006606
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.011089
License Number StateIL

VIII. Authorized Official

Name: MR. DAN LUTHER WILLIAMS II
Title or Position: PRESIDENT
Credential: LCSW
Phone: 773-255-0672