Provider Demographics
NPI:1083494751
Name:NTIM-ADDAE, ABENA (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:ABENA
Middle Name:
Last Name:NTIM-ADDAE
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 W NORTH SHORE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-6575
Mailing Address - Country:US
Mailing Address - Phone:331-269-5619
Mailing Address - Fax:
Practice Address - Street 1:1700 W IRVING PARK RD STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2596
Practice Address - Country:US
Practice Address - Phone:872-228-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
16145266OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE (CAQH)