Provider Demographics
NPI:1396573861
Name:SAGE & SOUL, L.L.C.
Entity type:Organization
Organization Name:SAGE & SOUL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAMIELE
Authorized Official - Middle Name:ANIECE
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-831-3143
Mailing Address - Street 1:643 E 50TH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3218
Mailing Address - Country:US
Mailing Address - Phone:630-800-9111
Mailing Address - Fax:
Practice Address - Street 1:643 E 50TH ST UNIT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-3218
Practice Address - Country:US
Practice Address - Phone:630-800-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty