Provider Demographics
NPI:1679913065
Name:COUNSELING CENTER OF ILLINOIS, INC.
Entity type:Organization
Organization Name:COUNSELING CENTER OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC CEAP SAP
Authorized Official - Phone:773-777-6767
Mailing Address - Street 1:4515 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3711
Mailing Address - Country:US
Mailing Address - Phone:773-777-6767
Mailing Address - Fax:773-777-7274
Practice Address - Street 1:4515 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3711
Practice Address - Country:US
Practice Address - Phone:773-777-6767
Practice Address - Fax:773-777-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health