MEDICARE: COUNSELING CENTER OF ARLINGTON HEIGHTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1164987533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING CENTER OF ARLINGTON HEIGHTS, LLC

Provider Business Mailing Address
First Line	:	3205 N WILKE RD STE 103C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0001
Country	:	US
Telephone Number	:	847-767-4719
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 N WILKE RD STE 103C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0001
Country	:	US
Telephone Number	:	847-767-4719
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OWNER
Name	:	TAMARA NOWAK
Credential	:	LCSW, CADC, JD
Telephone Number	:	847-767-4719

Provider Enumeration Date	:	02/09/2019
Last Update Date	:	02/09/2019

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