Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180011681 | IL |
NPI | 1003388224 |
---|---|
Provider Name | Celeste Haynes |
First Address | Chicago, IL 60644-3515 |
Second Address | Chicago, IL 60644-3515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2018 |
Last Update Date | 28/12/2018 |