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Organization
ORIGEM PSYCHOTHERAPY LLC
Active
Organization
ORIGEM PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMILA O. DE AZEVEDO LCPC (PSYCHOTHERAPIST, OWNER)
(312) 219-2476
Entity
Organization
Contact information
Practice address
1300 W BELMONT AVE STE 300, CHICAGO, IL 60657-3200
(312) 219-2476
Mailing address
1300 W BELMONT AVE STE 300, CHICAGO, IL 60657-3200
(312) 219-2476
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/11/2021
Last updated
12/13/2023
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