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General NPI Number Information
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NPI Number | 1962071449
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Entity Type | Organization
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Legal Business Name | ENERGETICS TRANSFORMATIVE COUNSELING LLC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 9950 N ALPINE RD STE 103
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City | MACHESNEY PARK
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State | IL
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Zip | 61115-8362
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Country | US
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Telephone | 815-871-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 5556 STOCKTON DR
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City | ROCKFORD
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State | IL
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Zip | 61109-1795
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Country | US
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Telephone | 815-871-4299
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Fax |
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Authorized Official
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Title or Position | LCPC
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Name | VANESSA KERNO
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Credential | LCPC
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Telephone | 815-871-4299
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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 |
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License Number State |
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