Provider Demographics
NPI:1508242090
Name:GHOLSON CONSULTING GROUP, LLC
Entity Type:Organization
Organization Name:GHOLSON CONSULTING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:GHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:217-202-8433
Mailing Address - Street 1:365 N JEFFERSON ST APT 2207
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1229
Mailing Address - Country:US
Mailing Address - Phone:217-202-8433
Mailing Address - Fax:
Practice Address - Street 1:365 N JEFFERSON ST APT 2207
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1229
Practice Address - Country:US
Practice Address - Phone:217-202-8433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149014440251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health