Healthcare Provider Details

I. General information

NPI: 1952216996
Provider Name (Legal Business Name): CREATE ANEW WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ATKINSON RD STE 203-205
GRAYSLAKE IL
60030-7817
US

IV. Provider business mailing address

100 S ATKINSON RD STE 203-205
GRAYSLAKE IL
60030-7817
US

V. Phone/Fax

Practice location:
  • Phone: 787-553-7603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAMARI ORTIZ
Title or Position: CO-OWNER
Credential: LCPC
Phone: 224-276-5490