Provider Demographics
NPI:1043509482
Name:COMMON THREADS COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:COMMON THREADS COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZIMMERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-217-9007
Mailing Address - Street 1:109 NARRAGANSETT CT
Mailing Address - Street 2:UNIT 12
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2883
Mailing Address - Country:US
Mailing Address - Phone:773-217-9007
Mailing Address - Fax:
Practice Address - Street 1:109 NARRAGANSETT CT
Practice Address - Street 2:UNIT 12
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2883
Practice Address - Country:US
Practice Address - Phone:773-217-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490143891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty