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General NPI Number Information
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NPI Number | 1881130748
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Entity Type | Organization
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Legal Business Name | DARA DENTON LLC
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 53 W. JACKSON BLVD SUITE 604
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City | CHICAGO
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State | IL
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Zip | 60604-3606
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Country | US
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Telephone | 612-444-1947
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Fax | 612-314-8570
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Provider Business Mailing Address
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Address Line | 53 W. JACKSON BLVD SUITE 604
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City | CHICAGO
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State | IL
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Zip | 60604-3606
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Country | US
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Telephone | 612-444-1947
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Fax | 612-314-8570
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MS. DARA JEFFERS DENTON
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Credential | LCPC
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Telephone | 612-723-1518
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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 | 180.009738
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License Number State | IL
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Taxonomy #2
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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 |
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