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General NPI Number Information
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NPI Number | 1003464595
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Entity Type | Organization
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Legal Business Name | NEW LIFE K.N.E.W. SOLUTIONS
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 4950 W. THOMAS STREET
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City | CHICAGO
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State | IL
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Zip | 60651-3118
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Country | US
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Telephone | 773-309-2050
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Fax | 833-882-7572
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Provider Business Mailing Address
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Address Line | 2512 S OAKLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60608-4913
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Country | US
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Telephone | 773-320-9592
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Fax | 883-882-7572
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. SHIRLYN MARIA GARRETT-WILSON
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Credential | LCPC
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Telephone | 773-320-9592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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