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General NPI Number Information
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NPI Number | 1205168424
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Entity Type | Organization
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Legal Business Name | INTERTWINED
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Dates
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Enumeration Date | 02/13/2010
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 10540 S WESTERN AVE STE 103
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City | CHICAGO
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State | IL
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Zip | 60643-2541
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Country | US
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Telephone | 708-499-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 10540 S WESTERN AVE STE 103
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City | CHICAGO
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State | IL
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Zip | 60643-2541
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Country | US
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Telephone | 708-499-2030
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Fax | 708-634-3688
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROCHELLE JOHNSON
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Credential | LCSW
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Telephone | 708-499-2030
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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 | 180005742
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License Number State | IL
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011142
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License Number State | IL
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