Provider Demographics
NPI:1972962272
Name:VITALITY COUNSELING
Entity Type:Organization
Organization Name:VITALITY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-713-3993
Mailing Address - Street 1:135 PARK AVE
Mailing Address - Street 2:LL4
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4370
Mailing Address - Country:US
Mailing Address - Phone:847-713-3993
Mailing Address - Fax:847-713-3993
Practice Address - Street 1:1192 E ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3084
Practice Address - Country:US
Practice Address - Phone:847-713-3993
Practice Address - Fax:847-713-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty