Provider Demographics
NPI:1609316058
Name:SHAMARI COUNSELING AND MENTORING
Entity Type:Organization
Organization Name:SHAMARI COUNSELING AND MENTORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:OBAFEMI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MISA, CADC
Authorized Official - Phone:847-651-3730
Mailing Address - Street 1:5401 THELEN AVE
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7641
Mailing Address - Country:US
Mailing Address - Phone:847-651-3730
Mailing Address - Fax:
Practice Address - Street 1:5050 JOHNSBURG RD
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-7977
Practice Address - Country:US
Practice Address - Phone:224-308-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty