Provider Demographics
NPI:1558943514
Name:BLACK PEARL COUNSELING, LLC
Entity Type:Organization
Organization Name:BLACK PEARL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-303-6354
Mailing Address - Street 1:1220 IROQUOIS AVE STE 205A
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8579
Mailing Address - Country:US
Mailing Address - Phone:630-303-6354
Mailing Address - Fax:
Practice Address - Street 1:1220 IROQUOIS AVE STE 205A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8579
Practice Address - Country:US
Practice Address - Phone:630-303-6354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center