Individual
CHARLA WEATHERBY TRINIDAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, BC-DMT
Contact information
Practice address
1925 N MILWAUKEE AVE, CHICAGO, IL 60647-4345
(312) 445-0649
Mailing address
1925 N MILWAUKEE AVE, CHICAGO, IL 60647-4345
(312) 445-0649
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180006729
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180006729
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/02/2008
Last updated
04/20/2012
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