| Little Corey Venture Llc | |
|
187 W Quincy St Riverside IL 60546-2108 | |
| (708) 601-1576 | |
| Not Available |
| Full Name | Little Corey Venture Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 187 W Quincy St, Riverside, Illinois |
| Authorized Official Name and Position | Wayland Barber Smith (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 7086011576 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Corey Venture Llc 187 W Quincy St Riverside IL 60546-2108 Ph: (708) 601-1576 | Little Corey Venture Llc 187 W Quincy St Riverside IL 60546-2108 Ph: (708) 601-1576 |
| NPI Number | 1639901580 |
|---|---|
| Provider Enumeration Date | 08/19/2024 |
| Last Update Date | 08/19/2024 |
| Certification Date | 08/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639901580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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