Individual
DYAMOND BRUCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
721 N LASALLE DR, CHICAGO, IL 60654
(312) 655-7167
Mailing address
611 LARKSPUR LN, MATTESON, IL 60443-1771
(773) 354-2346
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/27/2021
Last updated
07/27/2021
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