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General NPI Number Information
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NPI Number | 1295481380
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Entity Type | Organization
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Legal Business Name | HER SOLE PURPOSE
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Dates
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Enumeration Date | 02/27/2022
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Last Update Date | 02/27/2022
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Provider Practice Location Address
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Address Line | 3128 ILLINOIS ST
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City | LANSING
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State | IL
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Zip | 60438-3005
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Country | US
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Telephone | 773-817-8959
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Fax |
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Provider Business Mailing Address
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Address Line | 3128 ILLINOIS ST
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City | LANSING
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State | IL
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Zip | 60438-3005
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Country | US
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Telephone | 773-817-8959
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Fax |
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Authorized Official
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Title or Position | FOUNDERLICENSED CLINICAL THERAPIST
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Name | TAJMAR CARTER
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Credential | LCSW
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Telephone | 708-821-8610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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