Provider Demographics
NPI:1679885180
Name:DOLIS, RITA J I
Entity Type:Individual
Prefix:MISS
First Name:RITA
Middle Name:J
Last Name:DOLIS
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RITA
Other - Middle Name:J
Other - Last Name:DOLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC
Mailing Address - Street 1:1607 W HOWARD ST
Mailing Address - Street 2:THIRD FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1675
Mailing Address - Country:US
Mailing Address - Phone:312-744-7617
Mailing Address - Fax:
Practice Address - Street 1:1607 W HOWARD
Practice Address - Street 2:THIRD FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626
Practice Address - Country:US
Practice Address - Phone:312-744-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1507 CADC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)