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General NPI Number Information
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NPI Number | 1316436967
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Entity Type | Organization
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Legal Business Name | OAK & IVY COUNSELING LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 2130 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60618
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Country | US
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Telephone | 312-709-1342
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Fax |
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Provider Business Mailing Address
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Address Line | 723 W ROSCOE ST APT 3
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City | CHICAGO
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State | IL
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Zip | 60657-6510
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Country | US
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Telephone | 312-709-1342
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CELIA HARDAMON
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Credential | LCSW
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Telephone | 312-709-1342
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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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