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Organization
SOUL WERK CAFE PLLC
Active
Organization
SOUL WERK CAFE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANIQUA FORD LCSW (OWNER/LEAD THERAPIST)
(773) 574-2570
Entity
Organization
Contact information
Practice address
4137 SAUK TRL STE 217, RICHTON PARK, IL 60471-1253
(708) 580-6042
Mailing address
4137 SAUK TRL STE 217, RICHTON PARK, IL 60471-1253
(708) 580-6042
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
05/07/2024
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