Provider Demographics
NPI:1659679983
Name:JAMES, VASHONTE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:VASHONTE
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 COMMERCIAL AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4801
Mailing Address - Country:US
Mailing Address - Phone:708-515-9163
Mailing Address - Fax:
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:904
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:312-203-2370
Practice Address - Fax:312-288-8613
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490155831041C0700X
IN34006574A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical