Provider Demographics
NPI:1922496355
Name:SOUL FRIENDS COUNSELING SERVICES
Entity Type:Organization
Organization Name:SOUL FRIENDS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFTERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-373-7149
Mailing Address - Street 1:787 PENRITH AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3612
Mailing Address - Country:US
Mailing Address - Phone:630-373-7149
Mailing Address - Fax:
Practice Address - Street 1:1080 NERGE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3235
Practice Address - Country:US
Practice Address - Phone:630-373-7149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.008719251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health