Provider Demographics
NPI:1790559300
Name:GOSSITT, AKYA CHARMEL (LSW)
Entity Type:Individual
Prefix:MISS
First Name:AKYA
Middle Name:CHARMEL
Last Name:GOSSITT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 S YALE AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3852
Mailing Address - Country:US
Mailing Address - Phone:773-981-6542
Mailing Address - Fax:
Practice Address - Street 1:6515 S YALE AVE APT 1C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3852
Practice Address - Country:US
Practice Address - Phone:773-981-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.105798104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker