Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1235723552 |
---|---|
Provider Name | Chandra Mccain |
First Address | Bolingbrook, IL 60490-4535 |
Second Address | Joliet, IL 60435-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2021 |
Last Update Date | 26/02/2021 |