Healthcare Provider Details

I. General information

NPI: 1750206389
Provider Name (Legal Business Name): SABRINA FULLILOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5569 W 95TH ST
OAK LAWN IL
60453-2356
US

IV. Provider business mailing address

1229 N AUSTIN BLVD APT 1
CHICAGO IL
60651-1054
US

V. Phone/Fax

Practice location:
  • Phone: 888-464-6177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number150.129671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: