Organization Name: | INTERTWINED |
NPI Number: | 1205168424 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROCHELLE CROSS (OWNER) |
Mailing Address: | 12514 S Arbor Dr Alsip |
State: | IL US |
Postal Code: | 608031093 |
Phone Number: | 7734256394 |
Fax Number: | |
NPI Enumeration Date: | 02/13/2010 |
NPI Last Update Date: | 02/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180005742 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |