Organization
LARKSPUR COUNSELING COLLABORATIVE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANCEY WICKSTROM LCSW (MANAGER)
(773) 510-4018
Entity
Organization
Contact information
Practice address
1950 W SUMMERDALE AVE, CHICAGO, IL 60640-1039
(773) 510-4018
Mailing address
1950 W SUMMERDALE AVE, CHICAGO, IL 60640-1039
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/12/2024
Last updated
04/12/2024
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