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General NPI Number Information
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NPI Number | 1063623940
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Entity Type | Organization
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Legal Business Name | LIFESKILLS CENTER, LTD
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 479 NORTH AVE
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City | ANTIOCH
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State | IL
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Zip | 60002-1323
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Country | US
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Telephone | 224-577-5022
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Fax | 847-395-9551
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Provider Business Mailing Address
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Address Line | 479 NORTH AVE
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City | ANTIOCH
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State | IL
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Zip | 60002-1323
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Country | US
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Telephone | 224-577-5022
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Fax | 847-395-9551
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN A WHITE
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Credential | LCSW
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Telephone | 224-577-5022
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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 | 149011526
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License Number State | IL
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