Provider Demographics
NPI:1649668260
Name:POWERS WELLNESS & CONSULTING GROUP, LLC
Entity type:Organization
Organization Name:POWERS WELLNESS & CONSULTING GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-332-7692
Mailing Address - Street 1:912 BLAZING STAR RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3555
Mailing Address - Country:US
Mailing Address - Phone:773-332-7692
Mailing Address - Fax:847-816-9724
Practice Address - Street 1:912 BLAZING STAR RD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3555
Practice Address - Country:US
Practice Address - Phone:773-332-7692
Practice Address - Fax:847-816-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty