Provider Demographics
NPI:1639623044
Name:A PROMISE FOR PARENTS
Entity Type:Organization
Organization Name:A PROMISE FOR PARENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW ABD
Authorized Official - Phone:815-758-1358
Mailing Address - Street 1:810 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4410
Mailing Address - Country:US
Mailing Address - Phone:815-758-1358
Mailing Address - Fax:815-758-1580
Practice Address - Street 1:810 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4410
Practice Address - Country:US
Practice Address - Phone:815-758-1358
Practice Address - Fax:815-758-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490134571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty