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General NPI Number Information
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NPI Number | 1962214585
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Entity Type | Organization
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Legal Business Name | MY JOURNII COUNSELING, LLC
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1411 PETERSON AVE STE 103
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City | PARK RIDGE
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State | IL
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Zip | 60068-5000
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Country | US
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Telephone | 773-896-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 S BLACKSTONE AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60615-3011
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Country | US
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Telephone | 773-896-7000
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DANIELLE SHEREE BLOCKER
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Credential | LSW
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Telephone | 773-896-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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