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Organization
PRAY GROUNDS
Active
Organization
PRAY GROUNDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENECHA DORSEY LCSW (LICENSED CLINICAL THERAPIST)
(708) 705-2642
Entity
Organization
Contact information
Practice address
10157 S WALLACE ST, CHICAGO, IL 60628-1841
(708) 705-2642
Mailing address
1519 W WARREN BLVD, CHICAGO, IL 60607-1819
(773) 669-6073
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568183374
OWNER'S NPI TYPE 1
IL
Enumeration date
12/12/2024
Last updated
12/12/2024
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