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General NPI Number Information
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NPI Number | 1972107837
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY COUNSELING CENTER
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Dates
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Enumeration Date | 11/22/2020
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Last Update Date | 11/22/2020
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Provider Practice Location Address
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Address Line | 34121 N US HIGHWAY 45 STE 210
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1774
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Country | US
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Telephone | 224-544-9749
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Fax |
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Provider Business Mailing Address
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Address Line | 1758 N BALDWIN AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-8703
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Country | US
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Telephone | 847-561-7068
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Fax |
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Authorized Official
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Title or Position | SENIOR THERAPIST
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Name | MARITZA SOLIS
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Credential | LCSW
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Telephone | 224-544-9749
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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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