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General NPI Number Information
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NPI Number | 1619328390
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Entity Type | Organization
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Legal Business Name | INCLUSIVITY COUNSELING, LLC
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 4737 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60640-7758
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Country | US
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Telephone | 773-930-8681
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Fax |
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Provider Business Mailing Address
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Address Line | 7433 N CLAREMONT AVE UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60645-1741
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Country | US
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Telephone | 773-930-8681
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Fax |
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Authorized Official
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Title or Position | CEO/PSYCHOTHERAPIST
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Name | ILLANA JORDAN
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Credential | LCSW
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Telephone | 773-930-8681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149015448
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License Number State | IL
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