Organization
CONSTELLATION COLLECTIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA LEVINE LCSW (STAFF THERAPIST)
(224) 215-6524
Entity
Organization
Contact information
Practice address
6666 N WESTERN AVE, CHICAGO, IL 60645-5106
(312) 857-6716
Mailing address
1401 W ELMDALE AVE UNIT 3, CHICAGO, IL 60660-2588
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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