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General NPI Number Information
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NPI Number | 1811859432
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Entity Type | Individual
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Provider Name | ADISSON AMS MED, LPC
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1111 N WELLS ST
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City | CHICAGO
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State | IL
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Zip | 60610-7635
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Country | US
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Telephone | 773-572-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 N RACINE AVE
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City | CHICAGO
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State | IL
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Zip | 60657-4230
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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 |
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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 |
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License Number State | IL
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