Provider Demographics
NPI:1114464559
Name:ROOTS AND WINGS COUNSELING CONSULTANTS, LLC
Entity Type:Organization
Organization Name:ROOTS AND WINGS COUNSELING CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CCTP
Authorized Official - Phone:630-408-2170
Mailing Address - Street 1:311 N 2ND ST
Mailing Address - Street 2:STE. 302
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1850
Mailing Address - Country:US
Mailing Address - Phone:630-590-9360
Mailing Address - Fax:630-590-9991
Practice Address - Street 1:311 N 2ND ST
Practice Address - Street 2:STE. 302
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1850
Practice Address - Country:US
Practice Address - Phone:630-590-9360
Practice Address - Fax:630-590-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty