Doctor Name: | LILLIE PRINCE |
NPI Number: | 1134590284 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149.017901 |
Business Practice Address: | 3001 Greenbay Road North Chicago, IL - 60064 |
Business Phone Number: | 2246101148 |
Business Fax Number: | |
Mailing Address: | 3909 Midway Dr, ISLAND LAKE |
State: | IL |
Postal Code: | 600429638 |
Phone Number: | 3129823778 |
Fax Number: | |
NPI Enumeration Date: | 10/15/2015 |
NPI Last Update Date: | 10/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.017901 |
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 |