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General NPI Number Information
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NPI Number | 1548534829
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Entity Type | Organization
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Legal Business Name | WHOLE FAMILY, INC
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Dates
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Enumeration Date | 03/03/2012
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Last Update Date | 03/03/2012
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Provider Practice Location Address
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Address Line | 1655 W SCHOOL ST
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City | CHICAGO
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State | IL
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Zip | 60657-1043
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Country | US
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Telephone | 312-519-3187
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Fax | 773-880-1315
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Provider Business Mailing Address
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Address Line | 1655 W SCHOOL ST
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City | CHICAGO
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State | IL
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Zip | 60657-1043
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Country | US
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Telephone | 312-519-3187
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Fax | 773-880-1315
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SARAH C. WATKIN
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Credential | LCSW
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Telephone | 312-519-3187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 149012783
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License Number State | IL
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