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General NPI Number Information
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NPI Number | 1912328212
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Entity Type | Organization
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Legal Business Name | CENTERED THERAPY CHICAGO PLLC
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Dates
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Enumeration Date | 01/04/2014
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 4050 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3067
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Country | US
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Telephone | 773-569-1426
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60640-3067
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Country | US
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Telephone | 773-569-1468
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BIANKA NICOLE HARDIN
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Credential |
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Telephone | 773-569-1426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006357
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License Number State | IL
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