Organization
GRANT ADVOCATE & COUNSELING SVC OF IL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERISA C. JOHNSON D.O. (PHYSICIAN OWNER)
(773) 629-0524
Entity
Organization
Contact information
Practice address
1649 E 50TH ST, #7E, CHICAGO, IL 60615-3128
(773) 629-0524
Mailing address
PO BOX 803031, CHICAGO, IL 60680-3031
(773) 629-0524
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
IL
Other
Enumeration date
01/08/2008
Last updated
01/08/2008
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