Healthcare Provider Details

I. General information

NPI: 1942147277
Provider Name (Legal Business Name): LATRICE L QUARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N OAK PARK AVE FL 2
OAK PARK IL
60301-1364
US

IV. Provider business mailing address

10331 S CRANDON AVE
CHICAGO IL
60617-5622
US

V. Phone/Fax

Practice location:
  • Phone: 773-423-8447
  • Fax:
Mailing address:
  • Phone: 773-633-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: