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General NPI Number Information
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NPI Number | 1205344173
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Entity Type | Organization
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Legal Business Name | SHAMARI MENTORING COMPANY
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Dates
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Enumeration Date | 01/13/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1020 W ROLLINS RD
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City | ROULD LAKE HEIGHTS
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State | IL
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Zip | 60073
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Country | US
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Telephone | 224-308-4108
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 THELEN AVE
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City | MCHENRY
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State | IL
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Zip | 60050-7641
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Country | US
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Telephone | 847-323-1199
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND DIRECTOR
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Name | MR. OLABODE OLUWOLE OBAFEMI
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Credential |
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Telephone | 224-308-4108
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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 | 180007662
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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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