Provider Demographics
NPI:1225396484
Name:GUARDIAN ANGEL COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-404-1046
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-1125
Mailing Address - Country:US
Mailing Address - Phone:312-404-1046
Mailing Address - Fax:
Practice Address - Street 1:12178 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7745
Practice Address - Country:US
Practice Address - Phone:312-404-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0088531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty