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General NPI Number Information
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NPI Number | 1942086111
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Entity Type | Organization
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Legal Business Name | CONGRUENCY INTEGRATED COUNSELING, PLLC
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 2313 S 4TH AVE
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City | RIVERSIDE
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State | IL
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Zip | 60546-1260
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Country | US
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Telephone | 847-986-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 106 W CALENDAR AVE STE 80
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City | LA GRANGE
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State | IL
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Zip | 60525-2325
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Country | US
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Telephone | 847-986-5385
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | EWELINA BOCH
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Credential | LCSW
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Telephone | 847-986-5385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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