Organization
HEAVENLY INTERVENTIONS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA SIMONE GAINES (OFFICE MANAGER)
(773) 782-6173
Entity
Organization
Contact information
Practice address
7421 S SOUTH CHICAGO AVE, CHICAGO, IL 60619-2035
(773) 782-6173
Mailing address
7421 S SOUTH CHICAGO AVE, CHICAGO, IL 60619-2035
(773) 782-6173
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
036100047
IL
Other
Enumeration date
02/26/2007
Last updated
10/28/2008
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