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General NPI Number Information
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NPI Number | 1366746984
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Entity Type | Organization
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Legal Business Name | CHILDREN AND FAMILIES SUPPORT SERVICES P.C.
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 2246 W LAWRENCE AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60625-1929
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Country | US
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Telephone | 773-271-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 2246 W LAWRENCE AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60625-1929
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Country | US
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Telephone | 773-271-6770
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MARLENE ABIODUN
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Credential | LCSW
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Telephone | 773-791-7706
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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 | 180.005188
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License Number State | IL
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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 | 149.008852
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License Number State | IL
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