Provider Demographics
NPI:1255871257
Name:COLLINS, SHUNQUA LAVITA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHUNQUA
Middle Name:LAVITA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 W SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5907
Mailing Address - Country:US
Mailing Address - Phone:773-931-0016
Mailing Address - Fax:
Practice Address - Street 1:1731 N. MARCEY ST. SUITE 535
Practice Address - Street 2:TERRY HEFTER ASSOCIATES, LLC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:312-280-1166
Practice Address - Fax:312-280-1199
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0175341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical