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General NPI Number Information
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NPI Number | 1205652419
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Entity Type | Organization
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Legal Business Name | UNITED AGAINST VIOLENCE, NFP
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 6636 S YALE AVE
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City | CHICAGO
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State | IL
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Zip | 60621-3836
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Country | US
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Telephone | 773-619-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 6636 S YALE AVE
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City | CHICAGO
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State | IL
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Zip | 60621-3836
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Country | US
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Telephone | 773-619-7247
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KENYATTA VAUGHN
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Credential |
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Telephone | 773-619-7247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/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 | 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 #5
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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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