Healthcare Provider Details

I. General information

NPI: 1477305514
Provider Name (Legal Business Name): TRUE BELIEVERS COMMUNITY CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 W 79TH ST
CHICAGO IL
60620-1104
US

IV. Provider business mailing address

459 W 79TH ST
CHICAGO IL
60620-1104
US

V. Phone/Fax

Practice location:
  • Phone: 773-966-5651
  • Fax:
Mailing address:
  • Phone: 773-966-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROL COLLUM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-966-5651