Doctor Name: | FAYA KACOS-SHIU |
NPI Number: | 1194118802 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | |
Business Practice Address: | 2905 Willow Ln C-1 Zion, IL - 600991478 |
Business Phone Number: | 8477460701 |
Business Fax Number: | 8479845693 |
Mailing Address: | 3010 Grand Ave, WAUKEGAN |
State: | IL |
Postal Code: | 600852321 |
Phone Number: | 8477460701 |
Fax Number: | 8479845693 |
NPI Enumeration Date: | 03/05/2015 |
NPI Last Update Date: | 03/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |