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General NPI Number Information
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NPI Number | 1780917914
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Entity Type | Individual
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Provider Name | MERRIAM ELIZABETH WAMBLE MS, LCPC, RDDP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 03/02/2014
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Provider Practice Location Address
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Address Line | 1731 N MARCEY ST SUITE 535 -TERRY HEFTER ASSOCIATES
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City | CHICAGO
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State | IL
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Zip | 60614-5373
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Country | US
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Telephone | 312-280-1166
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Fax | 312-280-1199
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Provider Business Mailing Address
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Address Line | 1731 N MARCEY ST SUITE 535 -TERRY HEFTER ASSOCIATES
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City | CHICAGO
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State | IL
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Zip | 60614-5373
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Country | US
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Telephone | 312-280-1166
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Fax | 312-280-1199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 180000853
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License Number State | IL
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