Provider Demographics
NPI:1568007433
Name:JOLY, CHRISTINA (LCOC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:JOLY
Suffix:
Gender:F
Credentials:LCOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6056 N WASHTENAW AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3931
Mailing Address - Country:US
Mailing Address - Phone:773-818-8081
Mailing Address - Fax:773-820-8991
Practice Address - Street 1:5537 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1405
Practice Address - Country:US
Practice Address - Phone:773-818-8081
Practice Address - Fax:773-820-8991
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional