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General NPI Number Information
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NPI Number | 1972167930
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Entity Type | Organization
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Legal Business Name | REACHING MY DESTINATION COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 10540 S WESTERN AVE STE 403
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City | CHICAGO
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State | IL
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Zip | 60643-2529
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Country | US
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Telephone | 773-669-4743
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Fax | 773-634-7994
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Provider Business Mailing Address
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Address Line | 730 E 163RD PL
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2305
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Country | US
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Telephone | 773-425-4355
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Fax |
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Authorized Official
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Title or Position | LCPC
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Name | MRS. ALISHIA MERCHERSON
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Credential | MA
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Telephone | 773-669-4743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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