Healthcare Provider Details

I. General information

NPI: 1215648258
Provider Name (Legal Business Name): EMBRACE IT COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S URBANA AVE APT D
URBANA IL
61801-4266
US

IV. Provider business mailing address

907 W MARKETVIEW DR STE 10
CHAMPAIGN IL
61822-1250
US

V. Phone/Fax

Practice location:
  • Phone: 872-903-3711
  • 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
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SANDRA SLAYTON
Title or Position: OWNER
Credential: MS, LCPC
Phone: 872-903-3711