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General NPI Number Information
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NPI Number | 1508339953
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Entity Type | Individual
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Provider Name | CURISSA SUTHERLAND-SMITH PHD, LCPC, CRC, NCC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 4800 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60651-3226
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Country | US
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Telephone | 773-826-9925
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3096
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City | OAK PARK
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State | IL
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Zip | 60303-3096
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Country | US
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Telephone | 773-738-5906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180.015897
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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