Organization
COLLABORATIVE COUNSELING GROUP OF ILLINOIS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAMIEN JACKSON LCSW (OWNER)
(224) 766-9993
Entity
Organization
Contact information
Practice address
201 MAPLEWOOD AVE, MUNDELEIN, IL 60060-4129
(847) 807-5622
Mailing address
1 N OPLAINE RD UNIT 114, GURNEE, IL 60031-0804
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/23/2022
Last updated
06/23/2022
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