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General NPI Number Information
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NPI Number | 1861766107
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Entity Type | Organization
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Legal Business Name | CREATE COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1757 N KIMBALL AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60647-4805
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Country | US
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Telephone | 773-969-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 1757 N KIMBALL AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60647-4805
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Country | US
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Telephone | 773-969-6811
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. CHERIE L LUSKY
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Credential | LCPC
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Telephone | 773-969-6811
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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 | 180.007744
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License Number State | IL
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