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General NPI Number Information
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NPI Number | 1063604262
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Entity Type | Organization
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Legal Business Name | COTTAGE CLINIC COUNSELING, INC.
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 115 MOONEY DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2147
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Country | US
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Telephone | 815-932-8443
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Fax | 815-936-1295
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Provider Business Mailing Address
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Address Line | 115 MOONEY DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2147
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Country | US
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Telephone | 815-932-8443
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Fax | 815-936-1295
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCH.; PRESIDENT
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Name | DR. SHARON V. DIGIACOMO
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Credential | PSY.D.
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Telephone | 815-932-8443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State | IL
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