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General NPI Number Information
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NPI Number | 1063965010
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Entity Type | Organization
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Legal Business Name | CULTIVATING LIGHT, LLC
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST SUITE 1406
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-762-5335
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST SUITE 1406
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-762-5335
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | LILY PETER
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Credential | LCSW
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Telephone | 312-762-5335
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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 | IL
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