Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 26382 | IL |
NPI | 1003110289 |
---|---|
Provider Name | Ms. Shirley Ann Golladay |
First Address | Olympia Fields, IL 60461-1073 |
Second Address | Olympia Fields, IL 60461-1073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2011 |
Last Update Date | 03/01/2011 |