Organization Name: | SELF DESIGN, INC |
NPI Number: | 1023374261 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JULIE BLACKMAN (PRESIDENT/OWNER) |
Mailing Address: | 1007 Church St Suite 515 Evanston |
State: | IL US |
Postal Code: | 602013624 |
Phone Number: | 7738186800 |
Fax Number: | |
NPI Enumeration Date: | 04/02/2012 |
NPI Last Update Date: | 04/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.006816 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |