Provider Demographics
NPI:1255893939
Name:SISTA AFYA COMMUNITY MENTAL WELLNESS LLC
Entity type:Organization
Organization Name:SISTA AFYA COMMUNITY MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMESHA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-234-7994
Mailing Address - Street 1:503 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1817 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2000
Practice Address - Country:US
Practice Address - Phone:773-234-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty