Organization
GENERATIVE CHAOS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORA CUNNINGHAM LCPC (OWNER AND OPERATOR)
(773) 570-0498
Entity
Organization
Contact information
Practice address
1518 N CLEVELAND AVE # 1, CHICAGO, IL 60610-1110
(773) 570-0498
Mailing address
1518 N CLEVELAND AVE # 1, CHICAGO, IL 60610-1110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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