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Organization subpart
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Provider details

NPI number
Authorized official
SAMANTHA CARTER LCPC, LMHC (CEO)
(708) 359-5626
Entity
Organization

Contact information

Practice address
602 E 158TH ST, SOUTH HOLLAND, IL 60473-1533
(708) 359-5626
Mailing address
602 E 158TH ST, SOUTH HOLLAND, IL 60473-1533
(708) 359-5626

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—

Other

Enumeration date
07/18/2025
Last updated
08/05/2026
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