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General NPI Number Information
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NPI Number | 1124795992
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Entity Type | Organization
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Legal Business Name | LONG THREAD PSYCHOTHERAPY INC.
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 706 SEWARD ST
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City | EVANSTON
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State | IL
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Zip | 60202-2946
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Country | US
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Telephone | 847-331-2178
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 SHERMAN AVE # 151
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City | EVANSTON
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State | IL
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Zip | 60201-4421
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Country | US
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Telephone | 847-331-2178
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA M DINNOCENZO
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Credential | LCPC
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Telephone | 847-331-2178
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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 |
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License Number State |
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