Organization
SYDNEYMALCOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARION MALCOME LCSW (OWNER)
(312) 884-1893
Entity
Organization
Contact information
Practice address
307 N MICHIGAN AVE STE 410, CHICAGO, IL 60601-5318
(312) 884-1893
Mailing address
1420 S MICHIGAN AVE, CHICAGO, IL 60605-2811
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
149.013372
IL
Other
Enumeration date
02/08/2018
Last updated
02/08/2018
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