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General NPI Number Information
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NPI Number | 1790117885
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Entity Type | Organization
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Legal Business Name | LOFT COUNSELING, P.C,
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 3523 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1137
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Country | US
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Telephone | 773-263-3222
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Fax | 773-929-6762
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Provider Business Mailing Address
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Address Line | 1926 W ROSCOE ST #3S
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City | CHICAGO
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State | IL
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Zip | 60657-1051
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Country | US
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Telephone | 773-263-3222
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Fax | 773-929-6762
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Authorized Official
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Title or Position | LICENSED CLINICAL PROF COUNSELOR
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Name | ERIN COLETTE DIEDLING
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Credential | M.ED., LCPC
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Telephone | 773-263-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180008568
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License Number State | IL
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