Provider Demographics
NPI:1558823831
Name:JOINER HERROD, CARLA YOLANDA (LCSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:YOLANDA
Last Name:JOINER HERROD
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:YOLANDA
Other - Last Name:JOINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:820 S DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3728
Mailing Address - Country:US
Mailing Address - Phone:312-569-7732
Mailing Address - Fax:
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-7732
Practice Address - Fax:773-826-2793
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490080661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty