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General NPI Number Information
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NPI Number | 1124490826
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Entity Type | Organization
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Legal Business Name | L3 GROUP, LLC
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 212 E CULLERTON ST 509
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City | CHICAGO
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State | IL
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Zip | 60616-4328
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Country | US
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Telephone | 872-205-6550
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Fax |
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Provider Business Mailing Address
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Address Line | 212 E CULLERTON ST 509
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City | CHICAGO
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State | IL
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Zip | 60616-4328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LATRICE ANNETTE ALAGBALA
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Credential | PHD
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Telephone | 872-205-6550
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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 | 178.010329
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License Number State | IL
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