Individual
BIANCA GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 758-8616
Mailing address
6241 S KOLIN AVE, CHICAGO, IL 60629-5021
(773) 329-7666
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184154007
—
IL
Enumeration date
06/27/2019
Last updated
06/27/2019
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