Provider Demographics
NPI:1215365564
Name:CENTER FOR EMOTIONAL PEACE S.C.
Entity Type:Organization
Organization Name:CENTER FOR EMOTIONAL PEACE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-722-6118
Mailing Address - Street 1:110 GREEN BAY RD
Mailing Address - Street 2:APT. # 303
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-2148
Mailing Address - Country:US
Mailing Address - Phone:847-722-6118
Mailing Address - Fax:
Practice Address - Street 1:565 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1857
Practice Address - Country:US
Practice Address - Phone:847-984-6585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty