Provider Demographics
NPI:1639794605
Name:INTERSECTIONS CENTER FOR COMPLEX HEALING PLLC
Entity Type:Organization
Organization Name:INTERSECTIONS CENTER FOR COMPLEX HEALING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPSIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:872-356-8627
Mailing Address - Street 1:2035 W ARTHUR AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5788
Mailing Address - Country:US
Mailing Address - Phone:773-326-7904
Mailing Address - Fax:
Practice Address - Street 1:7751 S AVALON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3309
Practice Address - Country:US
Practice Address - Phone:872-356-8627
Practice Address - Fax:312-971-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty