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General NPI Number Information
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NPI Number | 1730752403
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Entity Type | Organization
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Legal Business Name | CHARISM COUNSELING CENTER
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 05/21/2022
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Provider Practice Location Address
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Address Line | 661 WEST LAKE STREET SUITE 2S
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City | CHICAGO
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State | IL
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Zip | 60661
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Country | US
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Telephone | 773-230-7536
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 W TAYLOR ST STE 152
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City | CHICAGO
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State | IL
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Zip | 60607-4623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | TIFFANY GREEN
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Credential | LCPC, MA, MBA, MDIV
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Telephone | 773-230-7536
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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 | 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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