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General NPI Number Information
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NPI Number | 1205174158
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Entity Type | Organization
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Legal Business Name | NORTH SHORE DANCE THERAPY, INC.
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 1516 GREENWOOD AVE
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City | DEERFIELD
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State | IL
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Zip | 60015-2714
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Country | US
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Telephone | 847-848-0697
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 GREENWOOD AVE
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City | DEERFIELD
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State | IL
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Zip | 60015-2714
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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 | CEO/PSYCHOTHERAPIST
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Name | MRS. ERICA JOY HORNTHAL
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Credential | MA, LCPC, BC-DMT
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Telephone | 847-848-0697
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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 | 180.007870
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License Number State | IL
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