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Organization
ROSE GOLD CROWNS
Active
Organization
ROSE GOLD CROWNS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE PORTIS LPC (CEO)
(773) 499-2360
Entity
Organization
Contact information
Practice address
620 E 101ST PL, CHICAGO, IL 60628-2242
(312) 800-1655
Mailing address
620 E 101ST PL, CHICAGO, IL 60628-2242
(312) 800-1655
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
02/26/2024
Last updated
02/26/2024
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