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General NPI Number Information
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NPI Number | 1306108758
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Entity Type | Organization
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Legal Business Name | TIME4CHANGECOUNSELING, LLC
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 1780 ASH ST #102
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City | NORTHFIELD
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State | IL
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Zip | 60093-3049
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Country | US
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Telephone | 224-730-3295
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Fax |
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Provider Business Mailing Address
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Address Line | 1780 ASH ST #102
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City | NORTHFIELD
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State | IL
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Zip | 60093-3049
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Country | US
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Telephone | 224-730-3295
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BARBARA ACKER
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Credential | LCSW
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Telephone | 224-730-3295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 149009537
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License Number State | IL
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