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General NPI Number Information
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NPI Number | 1669652913
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Entity Type | Organization
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Legal Business Name | RESOURCES FOR CHANGE, LTD
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Dates
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Enumeration Date | 11/04/2007
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 655 ROCKLAND RD STE 103
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1782
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Country | US
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Telephone | 847-309-3781
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Fax | 847-482-1688
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Provider Business Mailing Address
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Address Line | 655 ROCKLAND RD STE 103
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1782
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Country | US
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Telephone | 847-309-3781
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Fax | 847-482-1688
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DOUGLAS S LABELLE
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Credential | LCSW
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Telephone | 847-309-3781
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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 | 6891123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149003151
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License Number State | IL
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