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General NPI Number Information
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NPI Number | 1013457951
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Entity Type | Organization
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Legal Business Name | EMBRACE THE CENTER FOR EMOTIONAL WELLBEING LLC
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Dates
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Enumeration Date | 02/25/2017
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Last Update Date | 02/25/2017
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Provider Practice Location Address
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Address Line | 4305 N LINCOLN AVE STE M
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City | CHICAGO
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State | IL
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Zip | 60618-1807
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Country | US
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Telephone | 824-216-7793
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Fax | 855-727-4855
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Provider Business Mailing Address
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Address Line | 4305 N LINCOLN AVE STE M
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City | CHICAGO
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State | IL
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Zip | 60618-1807
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Country | US
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Telephone | 824-216-7793
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Fax | 855-727-4855
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA STEBBINS
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Credential | PSYD
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Telephone | 827-216-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071009049
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License Number State | IL
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