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General NPI Number Information
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NPI Number | 1760854970
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Entity Type | Organization
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Legal Business Name | STILLPOINT MENTAL HEALTH ASSOCIATES, SC
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 201 E OGDEN AVE SUITE 116
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City | HINSDALE
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State | IL
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Zip | 60521-3633
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Country | US
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Telephone | 630-325-8893
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E OGDEN AVE SUITE 116
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City | HINSDALE
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State | IL
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Zip | 60521-3633
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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 | PRACTICE ADMINISTRATOR
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Name | CHARMAINE CUSICK
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Credential |
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Telephone | 630-325-8893
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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 | 149.016971
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License Number State | IL
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