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General NPI Number Information
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NPI Number | 1619541216
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Entity Type | Organization
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Legal Business Name | ANCHORED SERENITY THERAPEUTIC SOLUTIONS, PLLC
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 1010 JORIE BLVD STE 246
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City | OAK BROOK
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State | IL
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Zip | 60523-3038
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Country | US
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Telephone | 708-576-4196
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Fax |
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Provider Business Mailing Address
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Address Line | 1634 BARNSDALE RD APT 207
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-1297
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Country | US
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Telephone | 708-819-9796
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | FANISHA CALVERT
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Credential | MS, LCSW
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Telephone | 708-819-9796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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