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Organization
OBSIDIAN HOLISTIC SERVICES, LLC
Active
Organization
OBSIDIAN HOLISTIC SERVICES, LLC
Active
Parent organization
SUGA BEAR CRAFTING ORGANIZATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUGA BEAR CRAFTING ORGANIZATION
Authorized official
MRS. ERICA WASHINGTON MA, LCPC, LMHC, NCC (DIRECTOR OF OPERATIONS)
(708) 462-2134
Entity
Organization
Contact information
Practice address
930 175TH ST STE 1E, HOMEWOOD, IL 60430-2078
(708) 462-2134
Mailing address
930 175TH ST STE 1E, HOMEWOOD, IL 60430-2078
(708) 462-2134
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
171100000X
Acupuncturist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
08/26/2020
Last updated
03/23/2023
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