| Collaborative Counseling Group Of Illinois Pllc | |
|
201 Maplewood Ave Mundelein IL 60060-4129 | |
| (847) 807-5622 | |
| Not Available |
| Full Name | Collaborative Counseling Group Of Illinois Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 201 Maplewood Ave, Mundelein, Illinois |
| Authorized Official Name and Position | Damien Jackson (OWNER) |
| Authorized Official Contact | 2247669993 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Collaborative Counseling Group Of Illinois Pllc 1 N Oplaine Rd Unit 114 Gurnee IL 60031-0804 Ph: () - | Collaborative Counseling Group Of Illinois Pllc 201 Maplewood Ave Mundelein IL 60060-4129 Ph: (847) 807-5622 |
| NPI Number | 1730810318 |
|---|---|
| Provider Enumeration Date | 06/23/2022 |
| Last Update Date | 06/23/2022 |
| Certification Date | 06/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730810318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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