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General NPI Number Information
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NPI Number | 1669744405
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Entity Type | Organization
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Legal Business Name | NOVO: RENEWING JOY IN LIFE, PC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 104 S 2ND AVE
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City | SAINT CHARLES
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State | IL
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Zip | 60174-1932
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Country | US
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Telephone | 630-297-3617
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Fax |
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Provider Business Mailing Address
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Address Line | 104 S 2ND AVE
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City | SAINT CHARLES
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State | IL
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Zip | 60174-1932
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Country | US
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Telephone | 630-297-3617
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VICKI ALDEN
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Credential |
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Telephone | 312-305-3443
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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