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General NPI Number Information
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NPI Number | 1619767811
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Entity Type | Organization
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Legal Business Name | DRIVE PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 4619 N RAVENSWOOD AVE # 104-D
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City | CHICAGO
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State | IL
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Zip | 60640-4580
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Country | US
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Telephone | 847-933-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 4619 N RAVENSWOOD AVE STE 104-D
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City | CHICAGO
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State | IL
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Zip | 60640-4580
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Country | US
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Telephone | 901-482-8052
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | ROBERT FOREMAN
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Credential |
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Telephone | 630-313-0069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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