Individual
DONITA MICHELLE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11225 FRONT ST, MOKENA, IL 60448-1303
(708) 537-7332
Mailing address
236 S PALMER DR, BOLINGBROOK, IL 60490-6571
(708) 580-2030
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
IL
Other
Enumeration date
11/10/2022
Last updated
11/10/2022
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