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General NPI Number Information
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NPI Number | 1477059913
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Entity Type | Organization
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Legal Business Name | CARRIE JAMESON LCPC LLC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 561 W DIVERSEY PKWY STE 214
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City | CHICAGO
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State | IL
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Zip | 60614-1682
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Country | US
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Telephone | 312-371-2646
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Fax |
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Provider Business Mailing Address
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Address Line | 519 W SURF ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60657-6014
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Country | US
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Telephone | 312-371-2646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE L JAMESON
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Credential | LCPC
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Telephone | 312-371-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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