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General NPI Number Information
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NPI Number | 1295004018
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER FOR EMOTIONAL GROWTH CORP.
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 3660 N. LAKE SHORE DRIVE, UNIT 3010
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City | CHICAGO
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State | IL
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Zip | 60613-5314
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Country | US
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Telephone | 708-373-1952
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Fax | 312-643-1341
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Provider Business Mailing Address
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Address Line | 3660 N. LAKE SHORE DRIVE, UNIT 3010
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City | CHICAGO
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State | IL
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Zip | 60613-5314
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Country | US
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Telephone | 708-373-1952
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Fax | 312-643-1341
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. GEORGETTE ELAIINE LEPAGE
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Credential | MS, LCPC
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Telephone | 847-967-0952
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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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Taxonomy #2
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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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