Provider Demographics
NPI:1184405623
Name:STATES OF WELLNESS COUNSELING PLLC
Entity type:Organization
Organization Name:STATES OF WELLNESS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-246-2075
Mailing Address - Street 1:13400 S ROUTE 59
Mailing Address - Street 2:SUITE 116 #177
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585
Mailing Address - Country:US
Mailing Address - Phone:815-246-2075
Mailing Address - Fax:
Practice Address - Street 1:13400 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5826
Practice Address - Country:US
Practice Address - Phone:815-246-2075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty