Provider Demographics
NPI:1851441984
Name:CONSTANCE FULLILOVE, PH.D., LTD.
Entity Type:Organization
Organization Name:CONSTANCE FULLILOVE, PH.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:FULLILOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-560-1808
Mailing Address - Street 1:205 W RANDOLPH ST
Mailing Address - Street 2:SUITE 830
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1867
Mailing Address - Country:US
Mailing Address - Phone:312-560-1808
Mailing Address - Fax:
Practice Address - Street 1:205 W RANDOLPH ST
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1867
Practice Address - Country:US
Practice Address - Phone:312-560-1808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty