Individual
JOHNIQUE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 WASHINGTON ST STE 200, WAUKEGAN, IL 60085-5564
(847) 441-5600
Mailing address
415 WASHINGTON ST STE 200, WAUKEGAN, IL 60085-5564
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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