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General NPI Number Information
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NPI Number | 1639623044
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Entity Type | Organization
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Legal Business Name | A PROMISE FOR PARENTS
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 810 S 4TH ST
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City | DEKALB
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State | IL
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Zip | 60115-4410
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Country | US
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Telephone | 815-758-1358
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Fax | 815-758-1580
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Provider Business Mailing Address
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Address Line | 810 S 4TH ST
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City | DEKALB
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State | IL
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Zip | 60115-4410
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Country | US
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Telephone | 815-758-1358
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Fax | 815-758-1580
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MRS. DENICE MARIE MOCK
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Credential | MSW LCSW ABD
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Telephone | 815-758-1358
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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 | 149013457
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License Number State | IL
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