Provider Demographics
NPI:1477059913
Name:CARRIE JAMESON LCPC LLC
Entity Type:Organization
Organization Name:CARRIE JAMESON LCPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-371-2646
Mailing Address - Street 1:519 W SURF ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6014
Mailing Address - Country:US
Mailing Address - Phone:312-371-2646
Mailing Address - Fax:
Practice Address - Street 1:561 W DIVERSEY PKWY STE 214
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1682
Practice Address - Country:US
Practice Address - Phone:312-371-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty