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General NPI Number Information
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NPI Number | 1528753605
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Entity Type | Organization
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Legal Business Name | WELLNESS CENTER FOR COUNSELING AND GUIDANCE
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 4449 S LAKE PARK AVE UNIT 2S
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City | CHICAGO
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State | IL
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Zip | 60653-4189
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Country | US
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Telephone | 312-525-1031
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Fax |
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Provider Business Mailing Address
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Address Line | 18125 ROY ST UNIT 20
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City | LANSING
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State | IL
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Zip | 60438-6601
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Country | US
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Telephone | 708-915-0517
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HESHIMA MANCE
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Credential | LCPC
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Telephone | 312-525-1031
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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 |
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License Number State |
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