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General NPI Number Information
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NPI Number | 1073090684
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Entity Type | Individual
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Provider Name | MINDY DARDON LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 5710 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60660-4302
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Country | US
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Telephone | 773-728-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 N LECLAIRE AVE
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City | CHICAGO
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State | IL
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Zip | 60639-3119
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Country | US
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Telephone | 312-505-7642
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 180.011738
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License Number State | IL
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