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General NPI Number Information
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NPI Number | 1679103097
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Entity Type | Organization
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Legal Business Name | INNER PEACES COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 73 W MONROE ST STE 228
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City | CHICAGO
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State | IL
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Zip | 60603-4955
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Country | US
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Telephone | 773-413-8054
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Fax |
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Provider Business Mailing Address
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Address Line | 6127 S UNIVERSITY AVE
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City | CHICAGO
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State | IL
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Zip | 60637-5894
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Country | US
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Telephone | 773-494-9457
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | DR. ANANCIA STAFFORD
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Credential |
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Telephone | 312-788-7703
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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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