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General NPI Number Information
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NPI Number | 1841799830
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Entity Type | Organization
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Legal Business Name | CARROLL CARES THERAPY CENTER
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 55 E MONROE ST STE 3800
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City | CHICAGO
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State | IL
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Zip | 60603-6030
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Country | US
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Telephone | 312-709-8722
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 S SOUTH SHORE DR APT 706
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City | CHICAGO
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State | IL
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Zip | 60649-2766
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Country | US
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Telephone | 312-709-8722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAYAMA CARROLL
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Credential | LCPC
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Telephone | 312-709-8722
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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 | 180010017
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License Number State | IL
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