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General NPI Number Information
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NPI Number | 1528134277
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Entity Type | Organization
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Legal Business Name | NORTHSIDE COUNSELING INC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 20130 SAMARA TRL
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City | LAKE ANN
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State | MI
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Zip | 49650-9685
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Country | US
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Telephone | 773-960-8359
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Fax |
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Provider Business Mailing Address
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Address Line | 20130 SAMARA TRL
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City | LAKE ANN
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State | MI
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Zip | 49650-9685
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Country | US
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Telephone | 773-960-8359
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN THOMPSON
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Credential | LCPC, LPC
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Telephone | 773-960-8359
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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 | 180000932
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License Number State | IL
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