Organization
FIFTH STAR COLLECTIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CONNOR WILLIAMS (CO-FOUNDER, SENIOR CONSULTANT)
(720) 982-9038
Entity
Organization
Contact information
Practice address
2711 N LAWNDALE AVE UNIT 2, CHICAGO, IL 60647-1127
(720) 982-9038
Mailing address
3914 W ALTGELD ST # 2E, CHICAGO, IL 60647-1004
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336597418
PERSONAL NPI
—
01
—
149.018440
LICENSED CLINICAL SOCIAL WORKER
IL
Enumeration date
10/17/2020
Last updated
11/13/2020
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