Organization
BRANCH COUNSELING AND WELLNESS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE M LEITHEISER LCSW (DIRECTOR)
(312) 874-8198
Entity
Organization
Contact information
Practice address
1200 N ASHLAND AVE, SUITE 205, CHICAGO, IL 60622-2259
(312) 874-8198
Mailing address
1200 N ASHLAND AVE, SUITE 205, CHICAGO, IL 60622-2259
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
105803102
IL
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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