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General NPI Number Information
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NPI Number | 1003634155
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIONAL CONNECTIONS COUNSELING & CONSULTING
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Dates
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Enumeration Date | 09/27/2024
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 3420 W FOSTER AVE STE A
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City | CHICAGO
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State | IL
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Zip | 60625-6971
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Country | US
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Telephone | 734-212-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 3953 W DAKIN ST UNIT 406
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City | CHICAGO
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State | IL
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Zip | 60618-3101
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Country | US
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Telephone | 248-736-0173
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. SHEDEH TAVAKOLI
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Credential | PH.D., LCPC, CRC
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Telephone | 734-212-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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