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Organization
SOULRECONSTRUCT PSYCHOTHERAPY
Active
Organization
SOULRECONSTRUCT PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIERRIA CHANNING COLEMAN LCPC (OWNER/LIC CLINI COUN)
(615) 424-2761
Entity
Organization
Contact information
Practice address
1136 S DELANO CT W STE B201, CHICAGO, IL 60605-3734
(312) 476-9682
Mailing address
1136 S DELANO CT W STE B201, CHICAGO, IL 60605-3734
(312) 476-9682
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/19/2021
Last updated
07/19/2021
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