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NPI Code Detail

MEDICARE: DR. CURISSA SUTHERLAND-SMITH PHD, LCPC, CRC, NCC

MEDICARE:  DR. CURISSA  SUTHERLAND-SMITH  PHD, LCPC, CRC, NCC
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
1101Y00000XCounselor180.015897IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1508339953
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CURISSA SUTHERLAND-SMITH PHD, LCPC, CRC, NCC
Provider Business Mailing Address
First Line : PO BOX 3096
Second Line :
City : OAK PARK
State : IL
Zip : 60303-3096
Country : US
Telephone Number : 773-738-5906
Fax Number :
Provider Business Practice Location Address
First Line : 4800 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60651-3226
Country : US
Telephone Number : 773-826-9925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2019
Last Update Date : 11/13/2024

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Directions to “ DR. CURISSA SUTHERLAND-SMITH PHD, LCPC, CRC, NCC” Practice Location

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