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General NPI Number Information
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NPI Number | 1609316058
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Entity Type | Organization
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Legal Business Name | SHAMARI COUNSELING AND MENTORING
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Dates
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Enumeration Date | 03/05/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5050 JOHNSBURG RD
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City | JOHNSBURG
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State | IL
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Zip | 60051-7977
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Country | US
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Telephone | 224-308-4108
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 THELEN AVE
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City | MCHENRY
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State | IL
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Zip | 60050-7641
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Country | US
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Telephone | 847-651-3730
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PROFESSIONAL COUN
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Name | MRS. RACHEL MARGARET OBAFEMI
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Credential | LCPC, MISA, CADC
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Telephone | 847-651-3730
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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 | 180.007662
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License Number State | IL
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