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General NPI Number Information
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NPI Number | 1073187415
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Entity Type | Organization
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Legal Business Name | SAMARITAN COUNSELING AND CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 111 N WABASH AVE BLDG 1156
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City | CHICAGO
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State | IL
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Zip | 60602-1903
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Country | US
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Telephone | 312-826-9480
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 EASTON MARKET # 1071
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City | COLUMBUS
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State | OH
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Zip | 43219-6023
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Country | US
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Telephone | 312-826-9480
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CHRISTINA JACKSON
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Credential | PHD
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Telephone | 312-826-9480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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