Individual
IDA J SAMUEL-CLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
8342 S PAXTON AVE, CHICAGO, IL 60617-1852
(312) 521-0796
Mailing address
8342 S PAXTON AVE, CHICAGO, IL 60617-1852
(312) 521-0796
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180011416
IL
Other
Enumeration date
02/06/2019
Last updated
05/27/2025
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