Individual
CARLOS MEDINA V
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2650 W MONTROSE AVE STE 102, CHICAGO, IL 60618-1562
(872) 228-9632
Mailing address
4504 N PAULINA ST APT 202, CHICAGO, IL 60640-5381
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178.018305
IL
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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