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General NPI Number Information
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NPI Number | 1740150424
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Entity Type | Organization
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Legal Business Name | NIGHTSHADE COUNSELING, PLLC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 9933 LAWLER AVE STE 505
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City | SKOKIE
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State | IL
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Zip | 60077-4302
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Country | US
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Telephone | 586-344-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 9933 LAWLER AVE STE 505
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City | SKOKIE
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State | IL
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Zip | 60077-4302
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Country | US
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Telephone | 586-344-0305
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOLLY G DESLANDES
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Credential | PSYD
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Telephone | 586-344-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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