Organization
COUNSELING CENTER OF GRAYSLAKE LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE PETTINATO LCSW (MANAGING DIRECTOR)
(847) 962-9549
Entity
Organization
Contact information
Practice address
142 HAWLEY ST STE 5, GRAYSLAKE, IL 60030-3653
(847) 962-9549
Mailing address
1190 E WASHINGTON ST, GRAYSLAKE, IL 60030-7960
(847) 962-9549
(847) 549-2235
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149.014706
LICENSE - SOCIAL WORKER, CLINICAL
IL
01
—
F300232686
MEDICARE PTAN
IL
Enumeration date
11/06/2016
Last updated
02/24/2022
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