Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180.009979 | IL |
NPI | 1003274135 |
---|---|
Provider Name | Ebony Ware |
First Address | Chicago, IL 60634-4955 |
Second Address | Chicago, IL 60634-4955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 03/02/2016 |