Organization
MIND OF CHRIST LIFE COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOMINIQUE SIMONE RUSSELL LCPC (OWNER)
(904) 452-6725
Entity
Organization
Contact information
Practice address
9200 S EMERALD AVE, CHICAGO, IL 60620-2741
(904) 452-6725
Mailing address
9200 S EMERALD AVE, CHICAGO, IL 60620-2741
(904) 452-6725
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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